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Diagnostic criteria for transient ischemic attack

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The diagnosis of transient ischemic attack (TIA) is fraught with problems; particularly this concerns the differentiation of TIA with its mimicking conditions. Explicit diagnostic criteria can improve the accuracy of TIA recognition. The authors of this paper propose new TIA diagnostic criteria

Objective: to elaborate TIA diagnostic criteria and to determine their sensitivity in a group of patients with TIA, as well as their specificity in those who suffered from migraine with aura from Russia and Denmark.

Patients and methods. TIA diagnostic criteria were developed using the International Classification of Headache Disorders (ICHD) and the data available in the literature on migraine with aura and on the clinical characteristics and diagnosis of TIA. The sensitivity of the criteria was tested in a prospective study of 120 patients who developed TIA before the elaboration of these criteria. The patients were questioned in the acute period of the disease through detailed semi-structured interviews. Eligible patients had focal brain or retinal ischemia with resolution of symptoms within 24 hours without acute brain tissue damage, as evidenced by diffusion-weighted magnetic resonance imaging (n=112) or computed tomography (n=8). These criteria were also tested for specificity in Danish (n=1390) and Russian (n=152) patients suffering from migraine with aura, the diagnosis of which was established according to ICHD-3 beta.

Results and discussion. The sensitivity of the proposed criteria in TIA patients was 99%. The specificity in the Danish and Russian patients with migraine with aura was 95% and 96%, respectively.

Conclusion. The new TIA diagnostic criteria are characterized by high sensitivity and specificity. These will be able to improve the diagnosis of TIA. It is recommended that the testing of these criteria in patients with TIA should be continued in future investigations.

About the Authors

E. R. Lebedeva
Urals State Medical University; International Headache and Facial Pain Center «Europe–Asia»; OOO «Medical Association “New Hospital”»
Russian Federation

Department of Emergency Medical Care, Urals State Medical University 

Contact: Elena Razumovna Lebedeva

3, Repin St., Yekaterinburg 620028

N. M. Gurary
Urals State Medical University; OOO «Medical Association “New Hospital”»
Russian Federation

Department of Emergency Medical Care, Urals State Medical University 

3, Repin St., Yekaterinburg 620028

J. Olesen
University of Copenhagen

Department of Neurology, University of Copenhagen, Danish Headache Center 

Nordre Ringvej 57, 2600 Glostrup, Copenhagen, Denmark


1. Kraaijeveld CL, van Gijn J, Schouten HJ, Staal A. Interobserver agreement for the diagnosis of transient ischemic attacks. Stroke. 1984 Jul-Aug;15(4):723-5.

2. Castle J, Mlynash M, Lee K, et al. Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke. 2010 Jul;41(7):1367-70. doi: 10.1161/STROKEAHA.109.577650. Epub 2010 May 27.

3. Gudkova VV, Shanina TV, Petrova EA, Stakhovskaya LV. Transient ischemic attack is a multidisciplinary problem. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(3):20-4. (In Russ.). doi: 10.14412/2074-2711-2012-397

4. Parfenov VA, Ragimov SK. Transient ischemic attacks. Nevrologicheskii zhurnal. 2011;(3):4-9. (In Russ.).

5. Parfenov VA, Ragimov SK. Masks of transient ischemic attack. Klinicheskaya gerontologiya. 2011;(7-8):25-30. (In Russ.).

6. Ferro JM, Falcao I, Rodrigues G, et al. Diagnosis of transient ischemic attack by the nonneurologist. A validation study. Stroke. 1996 Dec;27(12):2225-9.

7. Nadarajan V, Perry RJ, Johnson J, Werring DJ. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. 2014 Feb; 14(1):23-31. doi: 10.1136/practneurol-2013-000782.

8. Amort M, Fluri F, Schöfer J, et al. Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome. Cerebrovasc Dis. 2011;32(1):57-64. doi: 10.1159/000327034. Epub 2011 May 25.

9. Martin PJ, Young G, Enevoldson TP, Humphrey PR. Overdiagnosis of TIA and minor stroke: experience at a regional neurovascular clinic. QJM. 1997 Dec;90(12):759-63.

10. Prabhakaran S, Silver AJ, Warrior L, et al. Misdiagnosis of transient ischemic attacks in the emergency room. Cerebrovasc Dis. 2008; 26(6):630-5. doi: 10.1159/000166839. Epub 2008 Nov 4.

11. Albers GW, Caplan LR, Easton JD, et al. Transient ischemic attack--proposal for a new definition. N Engl J Med. 2002 Nov 21;347(21): 1713-6.

12. Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack. Stroke. 2009 Jun;40(6):2276-93. doi: 10.1161/STROKEAHA.108.192218. Epub 2009 May 7.

13. Classification committee of the international headache society. The international classification of headache disorders. Cephalalgia. 2018; 38: 1-211.

14. Fisher CM. Late-life migraine accompaniments – further experience. Stroke. 1986 Sep-Oct;17(5):1033-42.

15. Li D, Christensen AF, Olesen J. Field-testing of the ICHD-3 beta/proposed ICD-11 diagnostic criteria for migraine with aura. Cephalalgia. 2015 Aug;35(9):748-56. doi: 10.1177/0333102414559731. Epub 2014 Nov 25.

16. Harbison J. Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test. Stroke. 2003 Jan; 34(1):71-6.

17. Nor AM, Davis J, Sen B, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005 Nov;4(11):727-34.

18. Quinn TJ, Cameron AC, Dawson J, et al. ABCD2 scores and prediction of noncerebrovascular diagnoses in an outpatient population: a case-control study. Stroke. 2009 Mar; 40(3):749-53. doi: 10.1161/STROKEAHA.108.530444. Epub 2009 Jan 15.

19. Wardlaw JM, Brazzelli M, Chappell FM, et al. ABCD2 score and secondary stroke prevention. Meta-analysis and effect per 1,000 patients triaged. Neurology. 2015 Jul 28;85(4): 373-80. doi: 10.1212/WNL.0000000000001780. Epub 2015 Jul 1.

20. Dawson J, Lamb KE, Quinn TJ, et al. A recognition tool for transient ischaemic attack. QJM. 2009 Jan;102(1):43-9. doi: 10.1093/qjmed/hcn139. Epub 2008 Oct 15.

21. Lasserson DS, Mant D, Hobbs FD, Rothwell PM. Validation of a TIA recognition tool in primary and secondary care: implications for generalizability. Int J Stroke. 2015 Jul; 10(5):692-6. doi: 10.1111/ijs.12201. Epub 2013 Nov 10.

22. Dutta D. Diagnosis of TIA (DOT) scoredesign and validation of a new clinical diagnostic tool for transient ischaemic attack. BMC Neurol. 2016 Feb 9;16:20. doi: 10.1186/s12883016-0535-1.

23. Buchwald F, Strö m JO, Norrving B, Petersson J. Validation of Diagnoses of Transient Ischemic Attack in the Swedish Stroke Register (Riksstroke) TIA-Module. Neuroepidemiology. 2015;45(1):40-3. doi: 10.1159/000437266. Epub 2015 Jul 22.


For citations:

Lebedeva E.R., Gurary N.M., Olesen J. Diagnostic criteria for transient ischemic attack. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(2):12-19. (In Russ.)

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ISSN 2074-2711 (Print)
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