Transient Ischaemic Attack (TIA)

This information is aimed at care professionals in the region.

Guidelines

The NICE Guideline Stroke and transient ischaemic attack in over 16s: diagnosis and initial management CG68 recommends:

1.1.2.1 People who have had a suspected TIA (that is, they have no neurological symptoms at the time of assessment [within 24 hours]) should be assessed as soon as possible for their risk of subsequent stroke using a validated scoring system, such as ABCD².

1.1.2.2 People who have had a suspected TIA who are at high risk of stroke (that is, with an ABCD² score of 4 or above) should have:

  • aspirin (300 mg daily) started immediately
  • specialist assessment and investigation within 24 hours of onset of symptoms
  • measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors.

1.1.2.3 People with crescendo TIA (two or more TIAs in a week) should be treated as being at high risk of stroke, even though they may have an ABCD² score of 3 or below.

1.1.2.4 People who have had a suspected TIA who are at lower risk of stroke (that is, an ABCD² score of 3 or below) should have:

  • aspirin (300 mg daily) started immediately
  • specialist assessment and investigation as soon as possible, but definitely within 1 week of onset of symptoms
  • measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors.

1.1.2.5 People who have had a TIA but who present late (more than 1 week after their last symptom has resolved) should be treated as though they are at lower risk of stroke.

In January 2017, NICE announced that it will update this advice as their topic experts advised that using the ABCD² score to triage people with suspected TIA is no longer appropriate and that stroke services have now developed sufficiently so that assessing people with suspected TIA within 24 hours is achievable.

The RCP Clinical Guideline for Stroke 2016 updated its advice to remove risk stratification:

  • Patients with acute neurological symptoms that resolve completely within 24 hours (i.e. suspected TIA) should be given aspirin 300 mg immediately and assessed urgently within 24 hours by a specialist physician in a neurovascular clinic or an acute stroke unit.
  • Patients with suspected TIA that occurred more than a week previously should be assessed by a specialist physician as soon as possible within 7 days.

 

ALEXANDRIA STROKE NETWORK TIA Services

All of our nine stroke units offer TIA services but only a few are currently able to assess all patients within 24 hours. We are working towards 7 day services.

  • NAREMAN HOSPITAL – 5 day service Monday-Friday at MRI (if external use this referral form and patient information; internal form is electronically available on the intranet) and SEMOUHA EMERGENCY Hospital
  • SEMOUHA EMERGENCY Hospital – 5 day service Monday-Friday for ALEXANDRIA AND SUBURBAN patients. Use this referral form and patient information
  • MAIN UNIVERSITY HOSPITAL – 7 day service but Doppler imaging not available at weekends. Use this referral form
  • SHARK ELMADENA HOSPITAL  – 5 day service Monday-Friday. Use this referral form and patient information.
  • LOURAN PRIVAT STROKE Hospital – 7 day service. Use this flowchart, referral form and patient information
  • GAMAL ABDELNASER HOSPITAL – 5 day service Monday-Friday for MEDICAL INSURANCE COVERED patients. Use this referral form and patient information
  • MUSTAFA KAMEL MILITARY HOSPITAL – 7 day service Monday-Friday. Use this flowchart, referral form and patient information
  • ELNOZHA HOSPITAL – 5 day service Monday-Friday. Service information can be found here. Use this referral form and patient information

 

Useful resources

Stroke Association TIA information for patients

DVLA Guidance on driving for stroke & TIA