Transient ischaemic attack — MCCQE Part 1 MCQ

Correct answer: A — Send him immediately to an emergency stroke service for brain and vascular imaging, then institute cause-specific secondary prevention

Option A is best. Transient focal weakness and dysarthria within the past 48 hours constitute a highest-risk TIA presentation even after symptoms resolve. He should be sent immediately to an emergency department or rapid stroke pathway with brain imaging and concurrent head-and-neck vascular imaging before discharge. The evaluation must also exclude mimics and haemorrhage and identify the mechanism. Because atrial fibrillation is already known, confirmed TIA generally calls for oral anticoagulation rather than routine dual antiplatelet therapy, unless a contraindication or alternative mechanism changes the plan. Treatment timing is determined after imaging and clinical assessment. Reassurance, delayed outpatient testing, steroids, or bed rest would miss the period of greatest recurrent-stroke risk.

Reference: Canadian Stroke Best Practices, TIA triage and diagnostic evaluation: https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/triage-and-initial-diagnostic-evaluation-of-transient-ischemic-attack-and-non-disabling-stroke ; Anticoagulant therapy for atrial fibrillation: https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anticoagulation-for-individuals-with-stroke-and-atrials-fibrillation