update on tia kath pasco october 2010. primary prevention has been effective in fall in incidence...
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Update on TIAUpdate on TIA
Kath PascoKath Pasco
October 2010October 2010
Primary prevention has been effective in Primary prevention has been effective in fall in incidence of first strokefall in incidence of first stroke
Major improvements still required in Major improvements still required in secondary prevention following TIA and secondary prevention following TIA and minor strokeminor stroke
15-20% of patients 15-20% of patients with stroke report with stroke report preceding TIApreceding TIA
Warning events are Warning events are an opportunity for an opportunity for preventionprevention
Risk of up to 10% at 7 Risk of up to 10% at 7 daysdays
15% at 30 days15% at 30 days
Interval for Interval for intervention is shortintervention is short
Who to see and when?Who to see and when?
Patients with transient Patients with transient focal neurology focal neurology attributable to arterial attributable to arterial territoryterritory Symptom durationSymptom duration High risk versus low High risk versus low
riskrisk Vascular risk factorsVascular risk factors
Rapid reviewRapid review Driving adviceDriving advice AspirinAspirin
Aim of rapid reviewAim of rapid review
Carotid diseaseCarotid disease Atrial fibrillationAtrial fibrillation LV thrombusLV thrombus PFOPFO
TIA exclusionTIA exclusion
Carotid occlusionCarotid occlusion
Cardiac embolismCardiac embolism
AFAF LV thrombusLV thrombus PFOPFO
TIA mimicsTIA mimics
DemyelinationDemyelination TumourTumour Presyncope/syncopePresyncope/syncope SeizureSeizure MigraineMigraine Transient global amnesiaTransient global amnesia
Current ManagementCurrent Management
Medical therapyMedical therapy AntiplateletsAntiplatelets BP controlBP control StatinStatin Glucose toleranceGlucose tolerance
Carotid surgeryCarotid surgery
Consideration of Consideration of mechanism with mechanism with appropriate appropriate investigationinvestigation
Lifestyle adviceLifestyle advice Driving adviceDriving advice
TIA ServiceTIA Service
CurrentCurrent Ad hocAd hoc High risk via medical admissionHigh risk via medical admission Low risk through weekly clinicLow risk through weekly clinic CT same day but delay to carotid imagingCT same day but delay to carotid imaging Recent change to FDDHRecent change to FDDH
TIA ServiceTIA Service
FutureFuture 5/7 daily OP review with MRI/MRA5/7 daily OP review with MRI/MRA How best to ensure appropriate and rapid How best to ensure appropriate and rapid
referralreferral Weekend referrals through medical teamWeekend referrals through medical team Referral form?Referral form? Direct point of access?Direct point of access?
Your thoughts?Your thoughts?
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