Transient Ischemic Attacks (TIA)

Availability

North South North West Statewide

Pre-referral work-up

History

An appointment for TIA clinic can only be obtained through direct discussion with the Stroke Registrar (within hours) or on call Consultant (after hours). The referral, after discussion, should be faxed to the Neurology department on (03) 6173 0292.

Vascular risk factors: Smoking, hypertension, dyslipidaemia, diabetes, family history, obesity

ABCD2 score is a useful assessment tool in cases of TIA (not stroke) which assists in identifying those patients with a suspected or definite TIA who are at high risk of stroke however all cases of suspected TIA require urgent assessment regardless of their score.

AAge ≥ 60 years= 1 point
BBP > 140 systolic ±diastolic ≥90= 1 point
C

Clinical:
- Limb weakness
- Speech disturbance


= 2 points
= 1 point
D

Duration of TIA:
≥60 minutes
10-59 minutes
<10 minutes


= 2 points
= 1 point
= 0 points
DDiabetes= 1 point

Ischemic stroke presenting within 4.5 hours are eligible for consideration of thrombolysis.

If the patient still has residual neurological symptoms or signs they should attend the Emergency Department immediately.

Tests

Tests to consider:

  • CT brain - should be done prior to clinic appointment
  • Carotid ultrasound – if possible done prior to clinic appointment
  • FBC
  • UEC
  • Coagulation profile including INR if warfarnised
  • Fasting lipids
  • Fasting cholesterol
  • ECG (? AF) +/- Holter if intermittent palpitations or cardiac risks for paroxysmal AF

Interim/GP management

To refer a patient with this condition, please see the Neurology clinic page for the full referral process and templates.

Add or escalate antiplatelet therapy if there is no evidence of haemorrhage on CT brain.

Instruct patient to attend emergency if develops new symptoms or signs prior to clinic appointment.

Direct link to Health Pathways - TIA page or Stroke page

For more information please see the Tasmanian Health Pathways website.

Emergency

Acute stroke – residual neurological signs at time of examination

Crescendo TIAs

Urgent / category 1

All other suspected TIA

Routine / category 3

Incidental finding of old stroke on cerebral imaging done for other reasons

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Stroke Foundation 

Stroke Foundation Guide for GPs

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340 Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

We will endeavour to see these patients within two weeks.

Urgent referrals should be accompanied by a phone call, as per below:

  • Contact the Neurology Registrar directly within hours via the RHH switchboard Phone: (03) 6166 8308
Semi-urgent:
Routine:

Next available appointment