Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient presenting with symptoms suggestive of a transient ischaemic attack (TIA), the immediate investigations and actions from a General Practice perspective include:
- Exclude Hypoglycaemia: It is crucial to exclude hypoglycaemia as the cause of sudden onset neurological symptoms NICE NG128,NICE CKS.
- Immediate Referral for Specialist Assessment and Investigation: The patient should be referred immediately for specialist assessment and investigation, to be seen within 24 hours of symptom onset NICE NG128,NICE CKS. This assessment will determine further specific investigations.
- Brain Imaging Considerations:
- A computed tomography (CT) brain scan should generally not be offered to people with a suspected TIA unless there is a clinical suspicion of an alternative diagnosis that CT could detect NICE NG128.
- However, people with a bleeding disorder or those taking an anticoagulant should have an urgent CT scan to exclude haemorrhage NICE CKS.
- Avoid Scoring Systems: Do not use scoring systems, such as ABCD2, to assess the risk of subsequent stroke or to inform the urgency of referral for people with suspected or confirmed TIA NICE NG128,NICE CKS.
- Specialist Investigations (following referral): After specialist assessment, investigations such as MRI (including diffusion-weighted and blood-sensitive sequences) may be considered on the same day to determine the territory of ischaemia, detect haemorrhage, or identify alternative pathologies NICE NG128. Urgent carotid imaging should also be performed for anyone considered a candidate for carotid endarterectomy after specialist assessment NICE NG128.