When should I refer a patient with TIA symptoms to a specialist for further evaluation?

Refer a patient presenting with transient ischaemic attack (TIA) symptoms to a specialist immediately for assessment to be seen within 24 hours of symptom onset. This urgent referral should be made without using risk stratification tools such as ABCD2, as all suspected TIAs require prompt specialist evaluation and treatment initiation.

If the suspected TIA occurred more than 7 days previously, refer the patient for specialist assessment as soon as possible and at least within 7 days, as these patients are considered at lower risk.

For patients presenting with ongoing focal neurological deficits despite a negative FAST test, manage as acute stroke and arrange immediate emergency admission to an acute stroke facility.

Start aspirin 300 mg immediately unless contraindicated while awaiting specialist assessment.

Advise patients not to drive until they have been seen by a specialist who will provide definitive guidance.

These recommendations are based on UK national guidelines including NICE and the Royal College of Physicians, which emphasize the critical importance of assessment and treatment within 24 hours to reduce the risk of recurrent stroke by up to 80%.