BMJ Best Practice Podcast TIA - an update on diagnosis and management
Jul 1, 2022
In this engaging discussion, Dr. Jennifer Simpson, a vascular neurologist and associate professor at the University of Colorado, delves into the importance of timely diagnosis and management of transient ischemic attacks (TIAs). She highlights the critical risk of stroke following a TIA, especially in the first week. Dr. Simpson elaborates on essential diagnostic tests like MRI and echocardiograms, the role of antiplatelets and statins for prevention, and strategies for patient lifestyle changes. Her insights into the management of atrial fibrillation and the use of telemedicine provide valuable guidance for better care.
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Definition And Epidemiology Of TIA
- TIA is defined by transient focal neurological dysfunction without acute infarction on imaging.
- Most TIAs last under an hour and incidence is high worldwide, e.g., 200k–500k/year in the US.
Diagnose TIA By Clinical Localization
- Make the diagnosis clinically by localizing symptoms to a vascular territory and distinguishing negative from positive symptoms.
- Use collateral history and focus on sudden onset, maximal intensity, and absence of loss of consciousness to avoid mimics.
Essential Investigations After TIA
- Order MRI, vascular imaging, echocardiogram, and ECG tailored to the patient's risk factors.
- Consider prolonged heart monitoring when arrhythmia is suspected.