Background
Patients with acute focal neurological symptoms that resolve completely within 24 hours of onset should be considered for TIA workup.
NB: Any residual symptoms should raise concern for acute stroke
TIA is a medical emergency. Patients who have had a TIA are at high risk of further vascular events in the following days. Most require admission for urgent risk factor identification and modification.
EM Evaluation
- ECG (?atrial fibrillation)
- Routine bloods, incl FBC, U&E, blood glucose
- Immediate non-contrast CT Brain if concern for haemorrhage - otherwise advanced imaging can await Stroke Team input
- Give aspirin 300 mg immediately, unless contraindicated
Referral Pathway
Referral of patients with TIA can be done through any one of the below contacts:
- Mon-Fri 0800-1700: Stroke CNS (086-822-8122)
- Daily 0800-2000: Stroke Reg (via switch)
- Daily 2000-0800: Medical Reg On-Call
- Stroke Consultant (24/7 via switch)
Inpatient Evaluation
Secondary Prevention Management (coordinated by stroke team after diagnosis confirmed)
- Support to modify lifestyle factors (smoking, alcohol consumption, diet, exercise)
- Antiplatelet therapy (or anticoagulant therapy if in atrial fibrillation) if no contraindications
- High intensity statin therapy
- Anti-hypertensive therapy
Patients who have had a TIA, and are considered a potential candidate for carotid intervention, should have carotid imaging performed within 24 hours of assessment. Options for investigation include carotid duplex ultrasound, CT angiography or MR angiography.
Patients will commonly undergo Echo and Holter after discharge.