SHM's Clinical Quick Talks-Acute Inpatient Management of Transient Ischemic Attack

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This document provides a comprehensive overview of the acute inpatient management of Transient Ischemic Attack (TIA), defined as a temporary neurological dysfunction caused by focal ischemia without infarction.<br /><br />Etiologies of TIA include common causes such as atherosclerosis, cardioembolism (e.g., atrial fibrillation), and small vessel disease, along with rarer causes like arterial dissection, hypercoagulable states, vasculitis, and paradoxical embolism.<br /><br />History taking focuses on the timing and progression of symptoms, neurological deficits (weakness, numbness, speech or vision problems, vertigo), and relevant medical, medication, and family history.<br /><br />Typical TIA symptoms include sudden unilateral weakness or numbness, aphasia, monocular blindness, and homonymous hemianopia. Red flags indicating increased risk include symptoms lasting more than an hour, recurrent episodes, severe headache, altered consciousness, and seizure activity.<br /><br />Differential diagnoses commonly mimic TIA and include migraine with aura, seizures, syncope, hypoglycemia, Bell’s palsy, multiple sclerosis, brain tumors, metabolic encephalopathy, and peripheral neuropathy.<br /><br />Key laboratory and imaging evaluations urgently performed include CT head (to rule out stroke), CBC, electrolytes, glucose, renal function, coagulation studies, ECG, echocardiogram, diffusion-weighted MRI, and carotid imaging (Doppler, CTA, MRA) to assess stenosis or embolic sources.<br /><br />Treatment involves acute antiplatelet therapy with aspirin 300 mg immediately, followed by 75-100 mg daily, and addition of clopidogrel for 21 days if appropriate. Blood pressure management targets 130/80 mm Hg, avoiding aggressive lowering immediately post-event. High-intensity statins and glycemic control are key. Neurology consultation is essential, with vascular surgery or cardiology input as needed.<br /><br />The ABCD2 score stratifies stroke risk post-TIA, guiding management from outpatient care to immediate hospitalization.<br /><br />Pitfalls include delayed imaging, underestimating stroke risk, and neglecting modifiable risk factors. Early recognition and prompt treatment are critical to prevent subsequent ischemic strokes.

Asset Subtitle

Zain Abidin, Nicole Terrigno

Keywords

Transient Ischemic Attack

TIA management

acute inpatient care

neurological symptoms

stroke risk stratification

ABCD2 score

antiplatelet therapy

imaging evaluation

differential diagnosis

risk factors