TIA / NON-CODE STROKE

Question 1

MANAGEMENT: Mild ischemic stroke (NIHSS 0-3) or high risk TIA (ABCD2 score >/4)

Answer 1

STROKE LABS
ECG daily x 3
2-week Holter
CTA / MRA
MRI
Carotid Doppler: within 24 hr of stroke
Echo
A1c
LDL

ECG

CT / CTA Head and Neck

Carotid Imaging same visit or next day if after hours ER visit

Discharge to SSPC

Consult vascular surgery during that visit if symptomatic 50-99% carotid stenosis

Dual Antiplatelet Therapy for 21 Days
ASA: 162 mg loading dose then 81 mg daily
AND
Clopidogrel: 300 mg loading dose then 75 mg daily

NOAC if a. fib)

Question 2

DOCUMENTATION

Answer 2

When to refer to the stroke clinic and how quickly to refer:

Symptoms of unilateral weakness or aphasia between 48hours and 2 weeks
To see stroke within 24 hours
Symptoms of stoke that aren’t unilateral weekness or aphasia between 48 and 2 weeks to see stroke within 2 weeks
Symptoms more than 2 weeks ago to see stroke within a month

RISK FACTORS FOR STROKE AFTER A TIA
ABCD2

Age >60
BP >140/90
Clinical features of weakness and aphasia
Duration of symptoms >10 minutes
Diabetes

BP TARGETS AND MEDICATIONS
<140/90 for ischemic stroke or TIA, includes CKD
Small subcortical stroke <130
DM target <130/80
Nondiabetic CKD target <140/90
ACEi and Thiazide

LIPID TARGET AND MANAGEMENT
Target LDL <2 or 50%, if coronary dz target <1.8

Ischemic stroke & atherosclerotic disease with LDL > 1.8 on max Statin, add Ezetimibe 10 mg

With concomitant atherosclerotic disease where LDL target is not met, consider referral to professional with expertise in metabolic and lipid management or stroke

Hyper TG + ischemic stroke OR DM + vascular risk factors with TG > 1.5 mmol/L on Statin, consider icosapent ethyl 2g