Update on TIA Kath Pasco October 2010

 Primary prevention has been effective in fall in incidence of first stroke  Major improvements still required in secondary prevention following TIA and minor stroke

 15-20% of patients with stroke report preceding TIA  Warning events are an opportunity for prevention

 Risk of up to 10% at 7 days  15% at 30 days  Interval for intervention is short

Who to see and when?  Patients with transient focal neurology attributable to arterial territory Symptom duration Symptom duration High risk versus low risk High risk versus low risk Vascular risk factors Vascular risk factors  Rapid review Driving advice Aspirin

Aim of rapid review  Carotid disease  Atrial fibrillation  LV thrombus  PFO  TIA exclusion

Carotid occlusion

Cardiac embolism  AF  LV thrombus  PFO

TIA mimics  Demyelination  Tumour  Presyncope/syncope  Seizure  Migraine  Transient global amnesia

Current Management  Medical therapy Antiplatelets Antiplatelets BP control BP control Statin Statin Glucose tolerance Glucose tolerance  Carotid surgery  Consideration of mechanism with appropriate investigation  Lifestyle advice  Driving advice

TIA Service TIA Service  Current Ad hoc Ad hoc High risk via medical admission High risk via medical admission Low risk through weekly clinic Low risk through weekly clinic CT same day but delay to carotid imaging CT same day but delay to carotid imaging Recent change to FDDH Recent change to FDDH

TIA Service  Future 5/7 daily OP review with MRI/MRA 5/7 daily OP review with MRI/MRA How best to ensure appropriate and rapid referral How best to ensure appropriate and rapid referral Weekend referrals through medical team Weekend referrals through medical team Referral form? Referral form? Direct point of access? Direct point of access?

 Your thoughts?