Management of TIA and Minor Stroke

1. Wirral University Teaching Hospital NHS Foundation Trust Management of TIA and Minor Stroke SUSPECTED TIA/MINOR STROKE LIMB/FACIAL WEAKNESS, LOSS OF SPEECH OR MONOCULAR VISUAL LOSS TIA IS A MEDICAL EMERGENCY • A TIA is an acute loss of focal cerebral function resulting in sudden onset limb weakness, sensory disturbance or speech disturbance. It can also present as a transient monocular blindness (Amaurosis Fugax) • If your patient has had a TIA please refer now using the rapid access TIA/Minor Stroke Pathway • Transient dizziness, confusion, vertigo, double vision, syncope and drop attacks should not be referred as TIA in the absence of other neurological findings. If you would like these symptoms to be investigated please refer to General Medical Clinic • Have you informed your TIA patient not to drive? The DVLA advise that TIA patients do not drive for a least one month following their event LATE PRESENTATION TIA / MINOR STROKE i.e.> 24 HOURS SINCE ONSET NO ONSET WITHIN LAST 24 HOURS Every minute counts! Time is Brain YES HIGH RISK TIA OR STROKE ABCD2 SCORE ≥4 ≥2 TIA’S IN 1 WEEK ON WARFARIN AND/OR IN ATRIAL FIBRILLATION PROMINENT HEADACHE OR NECK PAIN LOWER RISK TIA • HIGH RISK TIA’S • If your patient has a symptomatic Carotid Artery Stenosis > 70% they have a 25% chance of having a disabling stroke in the next 18 months • Score of 4 or more = High Risk (8-20% chance of stroke) • Highest risk of stroke within next 48 hours NO YES NEED REFERRAL TO RAPID ACCESS TIA CLINIC NEED EMERGENCY ASSESSMENT & INVESTIGATION FAX TIA CLINIC REFERRAL PROFORMA (0151 604 7747) AND/OR BLEEP STROKE COORDINATOR ON 7009/ EXT 2279 (9-5PM, MON – FRI) DIRECT LINE 604 7397 PATIENT WILL BE SEEN WITHIN 7 DAYS BY STROKE PHYSICIAN +/- VASCULAR SURGEON ( GP’S WILL RECEIVE FAX RECEIPT WITH APPT. DATE) Wirral University Teaching Hospital NHS Foundation Trust SEND AS EMERGENCY ADMSSION TO A&E / CDU PATIENT MAY BE SUITABLE FOR THROMBOLYSIS (Arrival at hospital within 3 hours of onset essential) BLEEP OR CALL STROKE COORDINATOR DIRECT LINE 604 7397 (9-5PM, MON – FRI) START SECONDARY PREVENTION ASPIRIN 75MG +/- STATIN DO NOT ROUTINELY ARRANGE IMAGING UNTIL SEEN IN TIA CLINIC PLEASE Stroke Physicians; Dr D. Lowe, Dr G. Sangster, Prof.J.Barrett. Jan 2008 Web address for proforma - www.wirralstroke.nhs.uk