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2017 ; 8
(ä): 537
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction
for Research and Application in Clinical Practice
#MMPMID29104559
Abbott AL
; Silvestrini M
; Topakian R
; Golledge J
; Brunser AM
; de Borst GJ
; Harbaugh RE
; Doubal FN
; Rundek T
; Thapar A
; Davies AH
; Kam A
; Wardlaw JM
Front Neurol
2017[]; 8
(ä): 537
PMID29104559
show ga
BACKGROUND AND PURPOSE: Until now, stroke and transient ischemic attack (TIA)
have been clinically based terms which describe the presence and duration of
characteristic neurological deficits attributable to intrinsic disorders of
particular arteries supplying the brain, retina, or (sometimes) the spinal cord.
Further, infarction has been pathologically defined as death of neural tissue due
to reduced blood supply. Recently, it has been proposed we shift to definitions
of stroke and TIA determined by neuroimaging results alone and that neuroimaging
findings be equated with infarction. METHODS: We examined the scientific validity
and clinical implications of these proposals using the existing published
literature and our own experience in research and clinical practice. RESULTS: We
found that the proposals to change to imaging-dominant definitions, as published,
are ambiguous and inconsistent. Therefore, they cannot provide the
standardization required in research or its application in clinical practice.
Further, we found that the proposals are scientifically incorrect because
neuroimaging findings do not always correlate with the clinical status or the
presence of infarction. In addition, we found that attempts to use the proposals
are disrupting research, are otherwise clinically unhelpful and do not solve the
problems they were proposed to solve. CONCLUSION: We advise that the proposals
must not be accepted. In particular, we explain why the clinical focus of the
definitions of stroke and TIA should be retained with continued
sub-classification of these syndromes depending neuroimaging results (with or
without other information) and that infarction should remain a pathological term.
We outline ways the established clinically based definitions of stroke and TIA,
and use of them, may be improved to encourage better patient outcomes in the
modern era.