TIA Triage Trial and Evaluation of Vascular-Specific Inflammatory BiomarkerLp-PLA2 as a Stratification Tool for TIA Triage and Stroke Risk

Patients with a clinical suspicion of TIA seen at the Stanford Emergency Department, will be admitted to the Clinical Decision Area (CDA). The CDA is a short duration (<24 hrs)) hospitalization unit, where the patient can receive expedited evaluation and monitoring in a more comfortable setting than in the ED. Patients will be evaluated by a neurologist (resident with fellow or stroke attending). Clinical information will be collected in a dedicated chart.

Evaluation:

As recommended by the AHA, in the absence of contraindications, all the patients will undergo an MRI of the brain and a neck vessel evaluation as part of standard care. This exam will be obtained within 6 hours after patient admission to the emergency department. The diffusion sequence of the brain MRI will detect the presence of an acute injury related to a blood clot (ischemic injury), and the perfusion sequence will capture abnormal intra-cerebral blood flow. The other sequences will exclude the presence of other brain lesions susceptible to explain the transient symptoms presented by the patient. The MR angiogram (MRA) of the neck and intracranial vessels will detect the presence of a symptomatic stenosis that would require emergent treatment. In case of MRI contraindication, the patient will undergo a CT of the head and neck combining neck and intracranial vessel evaluation and perfusion imaging.

As recommended, patients will get an EKG and a cardiovascular examination as part of routine care.

As recommended, patients will get a standard lab evaluation as part of routine care including general chemistry, hematology, coagulation, lipid profile, Hb A1C), and if indicated, a specific prothrombotic and an inflammatory evaluation.