Table of Contents
ISRN Neurology
Volume 2011, Article ID 518621, 12 pages
http://dx.doi.org/10.5402/2011/518621
Review Article

The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review

1Spectrum Health, Grand Rapids, MI 49503, USA
2Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA
3Department of Neurology, Michigan State University, East Lansing, MI 48824-1046, USA

Received 21 March 2011; Accepted 10 April 2011

Academic Editors: C. G. Carlotti Jr., A. Di Carlo, and A. K. Petridis

Copyright © 2011 Archit Bhatt and Vishal Jani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes.