Transient ischemic attack in the practice of neurology in a low- and middle-income country

Abstract

Background

Transient ischemic attack (TIA) is a critical vascular event that often precedes strokes. Despite its significance, management varies widely across physicians.

Objective

To evaluate the knowledge and practices of Brazilian physicians regarding TIA diagnosis and management.

Methods

A survey was conducted among members of the Brazilian Academy of Neurology. It included questions about demographic information, TIA management practices, and knowledge of guidelines.

Results

While most respondents were neurologists or residents, there was significant variability in hospital admission, diagnostic testing, and treatment strategies. Many physicians relied on risk stratification tools but did not consistently follow guidelines for diagnostic imaging or medication.

Conclusion

These findings highlight the need for improved education and standardized protocols for TIA management in Brazil. Implementing public health policies to address these gaps could significantly reduce stroke recurrence rates and improve patient outcomes.

Keywords

Ischemic Attack, Transient - Stroke - Surveys and Questionnaires - Neurology - Neurologic Manifestations

Authors' Contributions

Conceptualization: MMA, LR, SCOM, FOL, WMA, RB, MCL; Data curation: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Formal analysis: STHM, MMA, LR, FOL, WMA, RB, MCL; Funding acquisition: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Investigation: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Methodology: STHM, MMA, LR, SCOM, FOL, WMA, MCL; Project administration: LR, RB, MCL; Resources: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Software: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Supervision: LR, RB, MCL; Validation: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Visualization: STHM, MMA, LR, SCOM, FOL, WMA, RB, MCL; Writing - original draft: STHM; Writing - review & editing: STHM, MMA, LR, SCOM, WMA, RB, MCL.

Data Availability Statement

The contents underlying the research text are included in the manuscript.

Editor-in-Chief: Ayrton Roberto Massaro.https://orcid.org/0000-0002-0487-5299.

Associate Editor: Antonio Arauz Góngora.https://orcid.org/0000-0002-3340-4138.

Publication History

Received: 06 May 2025

Accepted: 27 July 2025

Article published online:
15 October 2025

• References

• 1 Lioutas VA, Ivan CS, Himali JJ, Aparicio HJ, Leveille T, Romero JR. et al. Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA 2021; 325 (04) 373-381
• 2 Mendelson SJ, Prabhakaran S. Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review. JAMA 2021; 325 (11) 1088-1098
• 3 Clissold B, Phan TG, Ly J, Singhal S, Srikanth V, Ma H. Current aspects of TIA management. J Clin Neurosci 2020; 72: 20-25
• 4 Wolf ME, Held VE, Hennerici MG. Risk scores for transient ischemic attack. Front Neurol Neurosci 2014; 33: 41-68
• 5 Perry JJ, Losier JH, Stiell IG, Sharma M, Abdulaziz K. National Survey of Neurologists for Transient Ischemic Attack Risk Stratification Consensus and Appropriate Treatment for a Given Level of Risks. J Stroke Cerebrovasc Dis 2015; 24 (11) 2514-2520
• 6 Perry JJ, Mansour M, Sharma M, Symington C, Brehaut J, Taljaard M, Stiell IG. National survey of Canadian neurologists' current practice for transient ischemic attack and the need for a clinical decision rule. Stroke 2010; 41 (05) 987-991
• 7 Oostema JA, Brown MD, Reeves M. Emergency Department Management of Transient Ischemic Attack: A Survey of Emergency Physicians. J Stroke Cerebrovasc Dis 2016; 25 (06) 1517-1523
• 8 Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S. et al; American Heart Association Emergency Neurovascular Care Committee of the Stroke Council and Council on Peripheral Vascular Disease. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023; 54 (03) e109-e121
• 9 Shahjouei S, Sadighi A, Chaudhary D, Li J, Abedi V, Holland N. et al. A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78 (01) 77-87
• 10 Sanders LM, Srikanth VK, Blacker DJ, Jolley DJ, Cooper KA, Phan TG. Performance of the ABCD2 score for stroke risk post TIA: meta-analysis and probability modeling. Neurology 2012; 79 (10) 971-980
• 11 Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack?. Stroke 2006; 37 (07) 1710-1714
• 12 Wintermark M, Sanelli PC, Albers GW, Bello JA, Derdeyn CP, Hetts SW. et al; American Society of Neuroradiology, American College of Radiology, Society of NeuroInterventional Surgery. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery. J Am Coll Radiol 2013; 10 (11) 828-832
• 13 Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C. et al; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369 (01) 11-19
• 14 Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ. et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, POINT Investigators. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018; 379 (03) 215-225
• 15 Saxena R, Koudstaal P. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database Syst Rev 2004; 2004 (04) CD000187
• 16 Ranta A, Barber PA. Transient ischemic attack service provision: A review of available service models. Neurology 2016; 86 (10) 947-953