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afya
TIA
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Recognise - FAST (face, arm, speech test) ABCD2 assess (Age, BP >140/90, Clinical (one side - 2, speech only -1), Duration (10-60mins-1 >1hr-2), Diabetes score 4 or more - aspirin 300mg stat, specialist review in 24 hrs secondary prevent score 3 or less - specialist review in 1/52, image if uncertain Scan (specialist will sort) if score >4, on warfarin, in AF, or crescendo (2+/wk) ... also if indication for thrombolysis, bleeding tendency, GCS<13, unexplained progressive, fluctuating Sx, papilloedema, neck stiffness, fever, severe headache at onset Check swallowing Secondary prevent Hx - difficult as transient - chase witness Ex - mobility, co-ordination, posture, symmetry, speech, mood Ix - taylor to pt - avoid scan all Mx communicate well - diagnosis is overwhelming - early FUp focus on drugs and lifestyle - esp smoking driving - nil for 1/12, inform DVLA if PSV or HGV flying - avoid 6/52 Utilise - CVS, neuro, opthalmology, vascular surgeon, diabetes, renal Need good communication Differentiate - info relevant to TIA diagnosis and info related to vascular disease (risk factor for TIA) Vascular risk - AF, small vessel disease on MRI, AS on echo, carotid stenosis TIA - needs transient focal neuro Sx NOT LOC / seizure like activity ABCD2 risk of stroke at 2/7 - 0-3 - 1%, 4-5 4%, 6-7 8% may need carotid endarterectomy - under LA to assess neuro function during op so dec peri-op stroke risk guidelines say operate within 7/7 if new presentation of stenosis >70% Smoking, Alcohol, Driving, Flying, Rx HT and diabetes targets HbA1C <48 (6.5%), Chol <4, daily excersize, BMI <25, diabetic checks Clopidogrel - if not tolerated - Aspirin and Dipryidamole prevent stroke in ischaemic heart disease (MI) ? effective post TIA or ischaemic stroke beware inc GI bleed
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Neurology