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Clinicians who care for patients with TIA face two big problems. First, we are diagnostically deprived. Even among experts in cerebrovascular disease, agreement on the clinical diagnosis of TIA is remarkably poor.1 The cardiologist has EKG and troponin available to diagnose patients with acute chest pain at the bedside. As most patients with TIA present with normal neurologic examination results, the neurologist typically has only the patient's history. As those in active clinical practice can attest, some patients are better at telling that history than others.
Second, we are prognostically deprived. The high short-term risk of stroke following TIA is often emphasized, but the ability to identify this subgroup is distinctly suboptimal. Clinical risk scores, such as the ABCD2 score, have been proposed as useful bedside tools for this purpose.2 However, the ABCD2 score may be more limited in this regard than initially thought.3,4 MR diffusion-weighted imaging (DWI) is a more powerful tool for risk stratification, as patients with negative DWI are at extremely low risk of stroke.5 However, MRI has limited physical availability in most …
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