10 responses to “Transient Ischemic Attacks: High Risk and Treatable”

  1. This is interesting and coincides with a recent episode I treated……..

    Broca’s aphasia presenting at 7 pm.
    Did all that you describe except the imaging …… unavailable locally and no road link to hospital with same.
    After 4 days waiting for a bed at the nearest Stroke team she had improved enough to be discharged and will be followed up as an outpatient.

  2. With the high risk of a negative outcome, this aggressive approach to a TIA is clearly the way to go. A primary care physician, in an office setting, will still be faced with histories of transient neurological symptoms which are difficult to call. Is this a TIA? We’ll still have to decide at what level of suspicion we start the process, so this remains a challenging clinical judgement.

  3. May I ask in the section “What I do now” very impressive city management but of all the most important things to do, what about stressing “Examine the patient!” (completely). It’s what I teach the all the medical students, what I stress to the residents and what as a physician I want to see when I do physician assessments for the College of P&S. By the way our closest neurologist is 700 km away usually on impassable roads and a lot of the MDs in the province have limited access to be able to sent a patient to the ER for someone else to look after -if even available. So how about saying do a neurological exam. I think we family doctors should be able to do an adequate one.
    Michael Kawerninski MD CCFP FCFP
    Stewart B.C. (located on the border of B.C. and Alaska)

  4. Interesting plan for a perfect world unconstrained by $$ resources, patient agreement, geography and all those things physicians in most of the deal with daily. There is always some unique feature to a clinical scenario that makes treatment less than perfect. It would be helpful to address a plan for where most of us practice. For example some information about the use of antiplatelet therapy without access to timely imaging (prabably the biggest hurdle we face).

  5. I agree – very difficult to realize the follow through of investigations. Cariologist, Vascualar surgeons and Neurologist will not come for a TIA.

  6. I think it is an appropriately powerful statement to give the same weight to TIAs as we do UAs

  7. I think it is an INappropriately powerful statement to give the same weight to TIAs as we do to UAs.

    Certainly the risk is there, and the treament should be started today; but with UA at times the treatment should be started immediately, be placed on a cardiac monitor due to the risk of arrythmia and possibility of resuscitation, and the patient may need urgent transfer for angioplasty/stenting, etc. The same is not true for TIAs.

  8. Difficult to always make the call of TIA especially since most people present a bit after the fact but when suspicoan is high enough, definitely warrants aggressive approach.

  9. Stroke/TIA mimics huge problem. BC Stroke collaborative prompted me to more aggresively investigate TIA and not let person leave without basics and – at least – in place arrangements for rest. Same problems as mentioned -especially vasc surgery consult.

  10. what is the role of abcd2 vasc scores?

Leave a Reply