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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