Purpose
A transient ischaemic attack is defined as stroke symptoms and signs that resolve within 24 hours [1].
Sometimes known as minor stroke,
in which blood supply to the brain is temporarily disturbed leading to stroke like symptoms,
but where these symptoms resolve within 24 hours.
The cause of TIA is the same as the cause of an ischaemic stroke.
TIAs carry a significant mortality and morbidity risk.
They may be the only warning that a major stroke is imminent [2].
There is a 20 percent...
Methods and Materials
Case notes of patients presented with clinical symptoms and signs suggestive of TIA over a period of fifteen months where retrospectively identified and reviewed.
This included patients who have been referred electively by general practitioners to the nurse practitioner unit and those who have been admitted to the medical assessment unit (MAU) through accident and emergency department (A&E).
Patients were risk stratified into high risk (ABCD2≥4) and low risk (ABCD2<4).
Note review included age and sex of the patient,
whether MRI of the brain has...
Results
A total of 40 patients (23 males,
17 females; age range 35-90 years) have been referred to hospital with TIA.
Only four pateints (10%) underwent MRI studies,
none of which was done within time (0%).
None of the study group had a vascular territory confirmed nor a contraindication for MRI identified.
CT scans were done for 38 patients (95%) of which 35 patients (92%) had their CT done within time.
Of the 38 CT studies which were done,
CT confirmed ischaemia in only 7 patients...
Conclusion
This audit showedpoor compliance with national guidelines in imaging TIAs.
recommendations were made to improve adherence to the standard practice,
including the following:
local referral protocols should be agreed between primary and secondary care to facilitate the timely assessment of people who have had a TIA or minor stroke
investing in imaging services to diagnose TIA and stroke as management of subsequent risk of stroke will result in savings to acute care costs,
where more strokes will be prevented.
establishing a clear pathway for managing...
References
NICE guidelines: Stroke.
Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA).
National Institute of Health and Clinical Excellence,
2008.
National Stroke Strategy.
Department of Health,
2008.
National Sentinel Stroke Audit 2006.
Clinical Effectiveness and Evaluation Unit.
Royal College of Physicians,
2007.
Giles MF and Rothwell PM.
Substantial underestimation of the need for outpatient services for TIA and minor stroke in the UK.
Cerebrovasc Dis 2007; 23:17.
Rothwell PM,
Giles MF,
Chandratheva Aet al.
Effect of urgent treatment of transient ischaemic attack...