Transient ischemic attack and minor stroke - Revision history

Aidan at 23:04, 6 November 2022

2022-11-06T23:04:57Z

← Older revision		Revision as of 23:04, 6 November 2022
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	=== Routine ===		=== Routine ===

	* ECG for [[atrial fibrillation]] or [[Atrial flutter\|flutter]]		* ECG for [[atrial fibrillation]] or [[Atrial flutter\|flutter]], possibly followed by Holter monitor for up to 14 days
	* Consider echocardiogram, depending on clinical suspicion for cardioembolic source		* Consider echocardiogram, depending on clinical suspicion for cardioembolic source

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	* Medium or high risk: CTA including for carotid stenosis		* Medium or high risk: CTA including for carotid stenosis
	* Low risk: ultrasound with Dopplers as an outpatient		* Low risk: ultrasound with Dopplers as an outpatient

			== Differential Diagnosis ==

			* [[Migraine]], peripheral [[vertigo]], [[syncope]], [[somatization]] and [[seizure]]

	== Management ==		== Management ==

	* Dual antiplatelet therapy for medium- and high-risk patients for 21 days, followed by single antiplatelet therapy		* Dual antiplatelet therapy for medium- and high-risk patients for 21 days, followed by single antiplatelet therapy
			** [[Aspirin]] 80-81 mg p.o. daily plus [[clopidogrel]] 75 mg p.o. daily
			** Loading dose is [[aspirin]] 160 mg and [[clopidogrel]] 300-600 mg
			** [[Ticagrelor]] is an alternative to [[clopidogrel]]
			* Statin should be added in noncardioembolic strokes without contraindication
			** High-dose with atorvastation 80 mg or simvastatin 40 mg
			* If atrial fibrillation is identified, use anticoagulation
			** Can be started immediately if no active bleeding and no large acute infarction (>1.5 cm in anterior or posterior circulation) on CT
			** If moderate-to-large infarction, repeat CT at 3 to 7 days before starting anticoagulation to rule out hemorrhagic transformation
			** Patients with hemorrhage can be started after 14 days
	* Treat modifiable risk factors, including [[hypertension]], [[smoking]], [[dyslipidemia]], and [[obesity]]		* Treat modifiable risk factors, including [[hypertension]], [[smoking]], [[dyslipidemia]], and [[obesity]]
	* Lifestyle modification		* Lifestyle modification including dietary changes and increased physical activity

	[[Category:Neurology]]		[[Category:Neurology]]

Aidan: Created page with "== Clinical Manifestations == * Presentations are myriad * Most classic is sudden loss of motor function and impaired speech * Not typically progressive, repetitive, or stereotyped * Symptoms are negative (loss of function) rather than positive == Investigations == === Canadian TIA Score === * Canadian Transient Ischemic Attack Score (see [https://www.mdcalc.com/calc/10421/canadian-transient-ischemic-attack-tia-score MDCalc]) * Categorizes them into low (<1%), me..."

2022-11-06T22:50:28Z

Created page with "== Clinical Manifestations == * Presentations are myriad * Most classic is sudden loss of motor function and impaired speech * Not typically progressive, repetitive, or stereotyped * Symptoms are negative (loss of function) rather than positive == Investigations == === Canadian TIA Score === * Canadian Transient Ischemic Attack Score (see [https://www.mdcalc.com/calc/10421/canadian-transient-ischemic-attack-tia-score MDCalc]) * Categorizes them into low (<1%), me..."

New page

== Clinical Manifestations ==

* Presentations are myriad
* Most classic is sudden loss of motor function and impaired speech
* Not typically progressive, repetitive, or stereotyped
* Symptoms are negative (loss of function) rather than positive

== Investigations ==

=== Canadian TIA Score ===

* [[Canadian Transient Ischemic Attack Score]] (see [https://www.mdcalc.com/calc/10421/canadian-transient-ischemic-attack-tia-score MDCalc])
* Categorizes them into low (<1%), medium (1-5%), or high (>5%) risk for stroke within 7 days

=== Routine ===

* ECG for [[atrial fibrillation]] or [[Atrial flutter|flutter]]
* Consider echocardiogram, depending on clinical suspicion for cardioembolic source

=== Imaging ===

* Urgent CT brain, within 48 hours of onset
* Vascular imaging depends on risk
* Medium or high risk: CTA including for carotid stenosis
* Low risk: ultrasound with Dopplers as an outpatient

== Management ==

* Dual antiplatelet therapy for medium- and high-risk patients for 21 days, followed by single antiplatelet therapy
* Treat modifiable risk factors, including [[hypertension]], [[smoking]], [[dyslipidemia]], and [[obesity]]
* Lifestyle modification

[[Category:Neurology]]