TIA management

Figure. One approach to management of patients with transient ischemic attack. ER, Extended-release; ICA, internal carotid artery; INR, international normalized ratio; IV, intravenous; LMWH, low-molecular-weight heparin; UFH, unfractionated heparin.

KEY CONCEPTS

• Clinical features that predict increased short-term risk of stroke after transient ischemic attack include older age,hypertension, diabetes, symptoms of weakness or speechimpairment, and symptom duration greater than 10minutes.
• Magnetic resonance imaging with diffusion-weighted imaging and vascular imaging may play an important role in risk-stratifying patients with transient ischemic attack.
• Flat head positioning, isotonic fluid administration, and permissive hypertension are basic measures to improve cerebral blood flow and mitigate cerebral ischemia.
• For most patients with transient ischemic attack, aspirin should be started as soon as neuroimaging has ruled out the possibility of hemorrhage.
• The specific cause of the transient ischemic attack in individual patients must be determined to select the most appropriate long-term preventive therapy.
• Patients who experience stroke after transient ischemic attack
  should be considered for thrombolysis.

Ann Emerg Med. 2008;52:S27-S39.