TIA

Focal neurological symptom or sign that lasts <24hrs bought on by a decrease in blood supply which renders the brain ischaemic in the area causing the symptom

Clinical

· Limb shaking TIA

· Capsular warning syndrome

o See (Neurology 2012, Vol 79, p1356)

Risk Stratification

ABCD2 score

Age	> or = to 60	1
BP	>140 sys and/or >/= 90 dsys	1
Clinical	Unilateral weakness Speech disturbance w/o weakness Other	2 1 0
Duration	>/= 60min 10-59min <10min	2 1 0
Diabetes	Present	1

	2 days	7 days	90 days
0-3 (Low)	1.0%	1.2%	3.1%
4-5 (Interm.)	4.1%	5.9%	9.8%
6-7 (High)	8.1%	11.7%	17.8%

Original ABCD Score (Lancet 2005)

Imaging for risk Ax

• Infarction predicts recurrence – OR~4
• Abnormal DWI on MRI gives OR ~5

* N.B. Patients with AF (especially elderly) are at high risk regardless of ABCD etc score and should all be considered high risk. (BMJ 2011 Jun 23; 342:d3653)

Treatment

• Early access to treatment
• EXPRESS study (Lancet 2008)
• Found an 80% reduction in recurrent stroke/TIA at 90days in patients seen immediately in a stroke clinic and prescribed appropriate medications
• ARR ~5% (NNT ~20)
• Intervention achieved a much higher rate of use of standard medications