Transient ischemic attack is a brief episode of neurological dysfunction caused by loss of blood flow in the brain, spinal cord, or retina without tissue death. Patients present with sudden onset double vision, transient blindness, hemiparesis or speech disturbance. Signs include unilateral motor weakness, speech deficits, facial drooping, abnormal tongue movement, dysphagia, diplopia, monocular blindness, dis-conjugate gaze, ataxia, nystagmus or vertigo. If any of the signs and symptoms are long-lasting then there is a strong possibility of stroke.
Medications:
Urgent CT scan to rule out evidence of intracranial haemorrhage.
If no evidence of haemorrhage on CT scan:
- Tab. Ecosprin 75 (Aspirin 75 mg) 1 tablet once a day. If patient is already on aspirin then increase the dose to 150 mg per day.
- Add tab. Clopikind 75 (Clopidogrel 75 mg) 1 tablet once a day.
Blood pressure management:
- Blood pressure should be lowered very slowly.
- Reduce diastolic blood pressure below 110 mm Hg within 10 minutes to 1 hour.
- Do not lower the blood pressure more than 20% in the first hour.
- Inj. Lobet (Labetalol 5 mg/ml) – 0.25 mg/kg i.v. over 2 minutes. Additional boluses of 40 mg at 10 minutes intervals until a desired supine blood pressure is achieved (maximum dose – 300 mg).
- Once blood pressure is controlled switch to oral anti-hypertensives (refer to our guidelines on hypertension).
Investigations:
- CT brain – to rule out cerebral haemorrhage.
- CT Angiogram of brain – to rule out cerebral infarct.
- ECG – to rule out myocardial infarct, arrythmias.
- 2D Echo – to rule out intra-cardiac clot or valvular dysfunction as the cause for TIA.
- MRI scan of brain – particularly look for posterior circulation anomalies.
- Blood glucose – to assess control of diabetes.
- Serum electrolytes – to rule out other reasons for acute confusion.
- Prothrombin time and aPTT – to rule out bleeding disorders.
General advice:
- Stop tobacco consumption.
- Bed rest till symptoms resolve.
- Ensure frequent follow up to assess neurological changes.
- Provide education to patients and family in terms of repeat episodes and signs of stroke.
- Ensure lipid and glucose control.
- Advice dietary changes to optimize lipid and sugar control.
Referral:
Urgent referral may be needed to the neurologist if symptoms progress or persists inspite of the above treatment.