medical emergency
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people with TIA at high risk of early stroke
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12% @ 7d
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20% @ 90d
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1/2 will occur wihtin first 48hrs after TIA
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85% of strokes that follow TIA will be fatal or disabling
-
-
diagnosis more likely to be correct:
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sudden onset of symptoms
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maximal neurological deficit at onset
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symptoms typical of focal loss of brain function
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unilateral weakness
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speech disturbance
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-
rapid recovery of symptoms
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30-60min
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if any residual symptoms
- manage for stroke compared to TIA
-
-
-
Immediate assessment and intervention
reduce the risk of stroke after TIA
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Aspirin
- 300mg stat if aspriin naive anad 75-150mg daily
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Risk assessment
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ABCD2
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Age >60 (1)
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BP ≥ 140/90 (1)
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Clinical features
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unilateral weakness (2)
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speech impairment without weakness (1)
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-
duration of symptoms
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≥ 60mins (2)
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10-59min (1)
-
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diabetes (on medication) 1
-
-
Risk of stroke:
-
0-3
-
2d 1%
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7d 1.2%
-
90d 3.1%
-
-
4-5
-
2d 4.1%
-
7d 5.9%
-
90d 9.8%
-
-
6-7
-
2d 8.1%
-
7d 11.7%
-
90d 17.8%
-
-
-
high risk:
-
ABCD2 score ≥ 4
-
cresencdo TIA
-
AF
-
taking OAC
-
require urgent assessment - def. within 24hrs
-
-
low risk
-
ABCD2 \< 4
-
more than 1 week after TIA symptoms
-
require specialist assessment and investigations within 7d
-
-
if treating dr confident of diagnosis; has ready acecss to brain and carotid imaging anad can initiate treatment
- specialist review may not be required
-
Immediate secondary prevention measures
-
assess risk factors
-
antiplatelet
-
aspirin
-
aspirin + dipyridamole
-
clopidogrel
-
-
BP lowering
-
statin
-
OAC
-
nicotine replacement
initiate at first point of health care i.e. immediately
do not need to wait for brain imaging (except OAC)
fully recovered = intracerebral haemorrhage risk very low
Follow-up
- 1 month
Early assessment and diagnosis
-
investigations
-
FBC
-
electrolytes
-
ESR
-
renal function
-
lipid
-
HbA1c
-
ECG
-