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?