Diagnosis and management of transient ischaemic attacks in accident and emergency. Issue 6 (November 1998)

• Record Type: Journal Article
• Authors: Libetta, C; Venables, G S
• Is Part Of: Journal of accident & emergency medicine. Volume 15:Issue 6(1998)
• Page Start: 374
• Page End: 379
• Publication Date: 1998-11
• Subjects: Emergency medicine -- Periodicals; 616.025
• DOI: 10.1136/emj.15.6.374
• Languages: English
• ISSNs: 2633-6138

Abstract

Abstract : Stroke is an important cause of morbidity and mortality. Often the first presentation of cerebrovascular disease is a TIA which will present to the A&E department. Patients who have had a TIA are at increased risk of stroke, myocardial infarction, and vascular death. The risk of stroke after a TIA is greatest in the first year (approximately 11.6%) with a risk of approximately 5.9% per year over the first five years. As the risk is highest in the first months following a TIA it is important that the patients are diagnosed accurately, investigated promptly, and referred appropriately for treatment in order that valuable time is not lost. For this reason A&E physicians have a valuable role in the initial assessment and management of the patient. It has been advocated that patients should be seen by a neurologist or physician with an interest in cerebrovascular disease within days of their symptoms and be prepared for surgery within two weeks after a TIA. While it is usually not possible to achieve this ideal, improved cooperation between A&E physicians and these neurologists, general physicians, and geriatricians should lead to the implementation of speedy efficient referral procedures which can only improve patient care. When you next see a patient with a TIA in the A&E department remember what they have to lose. Three questions relating to this article are: (1) How are TIAs subdivided and what clinical features allow this differentation? (2) What are the initial investigations that should be performed in A&E? (3) When are the risks of completed stroke greatest after a TIA? Enumerate these risks. How effective is aspirin at reducting this risks?