transient ischaemic attack (TIA)
TIA - to admit or Mx as outpatient?
most current thinking is that TIA
patients should be admitted under a neurology unit and have early investigations and lifestyle modifications to prevent stroke as risk of subsequent stroke within 28 days appears to be higher in TIA
patients discharged from ED compared to admitted patients.
currently admitted TIA
patients have a median LOS in hospital of ~5-6 days and although their 28day stroke rates are improved, it seems their 1 year stroke rates are no better than those who are not admitted for their TIA
this 5-6 day LOS in hospital further contributes to bed access block and increased morbidity and mortality for those non-TIA
patients not so lucky to be able to get a hospital bed in a timely manner.
why should hospital admission prevent early stroke?
why do admitted TIA patients have similar 1 yr stroke rates to non-admitted patients?
can we reduce subsequent stroke risk without resorting to inpatient care?
current principles of Mx of TIA in the ED
oxygen if hypoxic
FBE, U&E, glucose, (clotting if on warfarin or in AF)
early CT scan brain to exclude haemorrhage or other pathology
if the non-contrast CT scan of the brain is normal, there is no need to proceed to either a contrast CT scan or MR angiogram. MRI DW is the preferred neuroimaging technique if the non-contrast CT scan is normal as it has the greatest sensitivity for minor ischaemic injury which informs both diagnosis and prognosis.
gentle BP control if severely hypertensive
podcasts and other resources
tia.txt · Last modified: 2012/07/23 06:47 by gary1