Transient ischemic attack and minor stroke
From IDWiki
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 MDCalc)
- Categorizes them into low (<1%), medium (1-5%), or high (>5%) risk for stroke within 7 days
Routine
- ECG for atrial fibrillation or 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
