Approach to TIA

IMPORTANT: This app is intended for use by qualified healthcare professionals only. Always seek the advice of a qualified clinician before making any medical or prescribing decisions.

Approach to TIA is a comprehensive evidence-based clinical reference for the assessment and management of transient ischaemic attack. Built for neurologists, stroke physicians, emergency doctors, acute medicine physicians, and allied health professionals.

DEFINITION AND RISK SCORES
- Tissue-based vs time-based TIA definition (AHA 2009)
- Interactive ABCD2 score calculator with real-time risk stratification
- ABCD3-I score - superior to ABCD2 for high-risk identification
- DWI-positive TIA - now classified as minor ischaemic stroke
- Crescendo TIA - recognition and emergency management
- Amaurosis fugax and retinal TIA

IMMEDIATE ASSESSMENT
- Structured 8-step history including crescendo TIA recognition
- Focused neurological and cardiovascular examination
- FAST-negative posterior circulation strokes
- Complete urgent investigation protocol
- Additional investigations for young patients and vasculitis

URGENT IMAGING
- CT limitations in acute TIA - sensitivity only 40 percent
- MRI DWI gold standard - detects ischaemia within minutes
- DWI/FLAIR mismatch for unknown onset (WAKE-UP criteria)
- Carotid Doppler, CTA, MRA and DSA - indications and comparison
- Cardiac imaging - TTE, TOE, cardiac monitoring protocols
- EMBRACE trial - 30-day monitoring detects AF in 16 percent

ACUTE DRUG TREATMENT
- DAPT protocol - aspirin plus clopidogrel 21 days (POINT and CHANCE trials)
- THALES trial - ticagrelor alternative
- DOAC selection for AF - ELAN 2023 timing guidance
- Blood pressure management - start within 24 hours of TIA
- High-intensity statin (SPARCL trial)
- Special situations - AF, anticoagulated patients, mechanical valves

RISK STRATIFICATION
- 10 high-risk features requiring immediate admission
- Early stroke risk data - 48-hour to 90-day risk table
- EXPRESS study - urgent assessment reduces 90-day stroke risk by 80 percent
- SOS-TIA clinic outcomes evidence

TIA MIMICS
- 9 common mimics with distinguishing clinical features
- Migraine with aura, focal seizure (Todd paresis), hypoglycaemia
- FND, BPPV (HINTS exam)
- Transient global amnesia, space-occupying lesion, subdural haematoma
- MS relapse

CAROTID DISEASE
- NASCET grading - mild, moderate, severe, near-occlusion
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