Rate and Prognosis of Brain Ischemia in Patients With Lower-Risk Transient or Persistent Minor Neurologic Events

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Abstract
The clinical problem of patients with acute but transient or minor neurologic symptoms who present to the emergency department, acute care clinic, or office is first to determine if the diagnosis is truly due to brain ischemia and then to risk stratify. The problem is exactly akin to patients who present with chest pain. Ischemia is the most important diagnosis to exclude because of the threat of progression to infarction. Among the half million North Americans who had a transient ischemic attack (TIA) or minor stroke annually, 10% to 17% will experience an early recurrent stroke within 90 days.1,2 Alternate diagnoses (stroke mimics) comprise at least 50% of these presentations and generally have more benign prognoses.3,4 Research has shown that, even with a final diagnosis of TIA or minor stroke, the extent of investigations and treatment varies widely, suggesting that in a patient with an uncertain diagnosis, this variation may be even wider.5

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