Considerations When Managing Patients with TIA in the ED

When managing patients with TIA in the ED, it is important to consider the aetiology and be able to relate focal neurology to a specific vascular territory.

Some aetiologies are more amenable to treatment aimed at stroke prevention. The key causes to consider are symptomatic carotid stenosis and atrial fibrillation.

Learning bite

Detection of patients with carotid stenosis or atrial fibrillation enables prompt delivery of effective treatment to reduce the probability of a stroke.

The Oxfordshire Community Stroke project demonstrated that the risk of recurrent stroke is greatest in those with large vessel stenosis or atherosclerosis [9].

Major artery stenosis was associated with a stroke risk of 12.6% at 30 days as compared to a 2% risk for patients with small artery stenosis.

In consequence, while only 14% of strokes were caused by large artery atherosclerosis, these patients accounted for 37% of the recurrent strokes within 7 days (compared with 3.3% recurrence in patients with small vessel disease).

This supports the need for urgent carotid imaging and prompt endarterectomy where appropriate.