ABCD 2 Score May Discriminate Minor Stroke from TIA on Patient Admission
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ORIGINAL ARTICLE
ABCD2 Score May Discriminate Minor Stroke from TIA on Patient Admission Hui Zhao & Qingjie Li & Mengru Lu & Yuan Shao & Jingwei Li & Yun Xu
Received: 27 June 2013 / Revised: 12 August 2013 / Accepted: 29 August 2013 / Published online: 17 October 2013 # Springer Science+Business Media New York 2013
Abstract With the advent of time-dependent thrombolytic therapy for ischemic stroke, it has become increasingly important to differentiate transient ischemic attack (TIA) from minor stroke patients after symptom onset quickly. This study investigated the difference between TIA and minor stroke based on age, blood pressure, clinical features, duration of TIA, presence of diabetes, ABCD2 score, digital subtraction angiography (DSA) and blood lipids. One hundred seventyone patients with clinical manifestations as transient neurological deficits in Nanjing Drum Tower Hospital were studied retrospectively. All patients were evaluated by ABCD2 score, blood lipid test, fibrinogen, and Holter electrocardiograph and DSA on admission. Patients were categorized into TIA group or minor stroke group according to CT and MRI scan 24 h within symptom onset. The study suggested that minor stroke patients were more likely to have a higher ABCD2 score (odds ratio (OR) 2.060; 95 % confidence interval (CI) 1.293–3.264). Receiver-operating characteristic curves identified ABCD2 score >4 as the optimal cut-off for minor stroke diagnosis. Total serum cholesterol seemed a better diagnostic indicator to discriminate minor stroke from TIA (OR 4.815; 95 % CI 0.946–1.654) than other blood lipids in simple logistic regression, but not valuable for the differentiation between TIA and minor stroke in multivariate logistic regression. Higher severity of intracranial internal carotid stenosis, especially >90 %, were more likely to have minor stroke, but was not a reliable diagnostic indicator (P >0.05). ABCD2 could help clinicians H. Zhao : Q. Li : M. Lu : Y. Shao : J. Li : Y. Xu Department of Neurology, Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China H. Zhao : Y. Shao : J. Li (*) : Y. Xu (*) Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, People’s Republic of China e-mail: [email protected] e-mail: [email protected]
to differentiate possible TIA from minor stroke at hospital admission while blood lipid parameters and artery stenosis location offer limited help. Keywords TIA . Minor Stroke . ABCD2 Score . DSA . Blood Lipids
Introduction About 240,000 patients are diagnosed as transient ischemic attack (TIA) in the USA every year [1]. TIA and minor stroke are very common ischemic cerebrovascular diseases [2]. Some studies found that compared with the general population, patients with TIA or minor stroke have a high early risk of stroke [3, 4]. The management of TIA patients had been recommended in clinical guidelines, while for patients with minor stroke or non-disabling stroke, there is no specifi
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