What are the stroke protocols and procedures for handling a Transient Ischemic Attack (TIA)?

From the Guidelines

For handling a Transient Ischemic Attack (TIA), also known as a "mini-stroke," immediate medical attention is crucial. The recommended protocol involves prompt evaluation and treatment to prevent a full-blown stroke.

Key Steps in TIA Management

Upon identification of TIA symptoms, which include sudden weakness or numbness in the face, arm, or leg, difficulty with speech or understanding, sudden blurred vision, or severe headache, the following steps should be taken:

• Emergency Medical Services (EMS) Activation: Call for emergency medical help immediately.
• Initial Assessment: In the hospital setting, a rapid assessment should be conducted, including a neurological examination and review of the patient's medical history, as recommended by guidelines such as those from the National Stroke Association 1.
• Imaging: A non-contrast computed tomography (CT) scan of the head should be performed to rule out hemorrhage. Further imaging like MRI may be considered based on clinical judgment, with considerations for the use of CT angiography to assess both extracranial and intracranial circulation 1.
• Laboratory Tests: Blood tests should be conducted to evaluate for conditions that may mimic or contribute to TIA, such as blood glucose levels, complete blood count, electrolytes, and coagulation studies, as outlined in recommendations for the initial evaluation of TIA patients 1.
• Medication:
  • Aspirin: Administer aspirin 325 mg orally as soon as possible if there are no contraindications, based on guidelines for noncardioembolic TIA management 1.
  • Clopidogrel: May be considered in addition to or instead of aspirin based on patient-specific factors and clinical guidelines, with evidence suggesting its potential benefits in preventing further vascular events 1.
  • Antihypertensives: Manage blood pressure according to guidelines, typically aiming for a systolic blood pressure <220 mmHg and diastolic <120 mmHg, unless the patient has a contraindication, as recommended for acute stroke management 1.
• Further Management: Patients diagnosed with TIA should undergo a comprehensive evaluation to identify and manage risk factors for stroke, including but not limited to hypertension, diabetes, hyperlipidemia, and atrial fibrillation, with an emphasis on rapid assessment and initiation of preventive measures to reduce the risk of recurrent stroke 1.
• Follow-Up: Close follow-up with a neurologist or primary care physician is essential to monitor for recurrent symptoms and adjust the treatment plan as necessary, highlighting the importance of ongoing care in TIA management.

Given the high risk of subsequent stroke after a TIA, expedited evaluation and initiation of preventive measures are critical, with the goal of reducing the risk of a full-blown stroke and its devastating consequences, as emphasized by recent updates in stroke care guidelines 1.

From the Research

Stroke Protocols and Procedures for Handling a Transient Ischemic Attack (TIA)

• The current healthcare pathway for TIA focuses on preventing another stroke, but care for other long-term problems is not routinely given 2
• Prompt treatment following TIA can reduce the risk of subsequent stroke and disability, but many patients delay in making contact with medical services 3
• Awareness of typical stroke symptoms can lead to urgent action when more severe TIA symptoms are present, but can lead to delay when experienced symptoms are less severe 3
• The role of friends and family can vary widely in deciding on and enacting care-seeking decisions, and can impact on the delay in seeking medical help 3
• Healthcare professionals can also impact on patients' care-seeking, with greater delays in seeking further care for the same episode described when patients perceive a lack of urgency during initial healthcare interactions 3

Importance of Immediate Treatment

• Immediate treatment for TIA is crucial, as it can prevent a full stroke and reduce the risk of long-term problems 4
• Delay in seeking medical help can lead to worse quality of life and difficulty in returning to work and social activities 2
• Research priorities for TIA and minor stroke include understanding the existing care patients receive, exploring what optimal care post-TIA/minor stroke should comprise, and identifying and treating impairments 2

Classification of Mild Stroke

• There is inconsistency in the classification of mild stroke, with varying use of stroke severity assessments, measurement cutoff scores, imaging tools, and clinical or functional outcomes 5
• The National Institutes of Health Stroke Scale is the most widely used measure to classify stroke severity, but different cutoff points are used 5
• A consensus definition of mild stroke is necessary to develop effective treatment and referral strategies, and to improve health service delivery 5