Approach to Transient Ischaemic Attacks

Axioms: A TIA is like a stroke that spontaneously resolves. It is not a syncopal episode (LOC is atypical!) and typically involves focal neurology (unilateral weakness and speech disturbance). It is very significant because of a high likelihood of an impending stroke.

Do you know how to?
1) rule out mimics
2) assess severity
3) formulate plan based on severity.

... rule out mimics and ICH.
Rule out the 6S:

• Syncope
• Seizure
• Sugar
• Sepsis
• Space Occupying Lesion
• Subarachnoid Haemorrhage

Rarely, atypical migraines (without headache) can present similarly to TIAs with focal neurology.

CTB CTB CTB

Intracranial Haemorrhage can mimic a TIA. This is especially necessary in patients on anticoagulation.

... determine the severity

ABCD2 Stratification

Age >75 (1)

BP > 140/90 (1)

Clinical: Unilateral Weakness (2), Speech (1)

Duration: >10min (1) >60min (2)

Diabetes (1)

*ABCD2 does not apply to people with past TIA's. They should be treated in the highest risk category below.

... further mx based on severity

[1-2] Mild Risk

- Asprin

- Arrange OP carotid doppler and echocardiogram.

- r/v in TIA clinic within a week.

[3-4] 6% risk of stroke in 2 days.

- Asprin+Dipyridamole (Assasantin)

- Clopidogrel

- High dose statin (~80mg)

- Perindopril + Indapamide target BP <130 systolic.

- Urgent carotid doppler.

- Urgent echocardiogram.

[5+] You're out of your league. Refer this patient to a neurologist.

- Consider thrombolysis.