Stroke-Transient Cerebral Ischaemic Attacks (TIAs) A Medical Emergency-Preventable and Treatable.

TIA is a serious condition and a medical emergency requiring immediate evaluation and treatment to prevent a stroke. Confirmation of diagnosis is vital. Medical conditions like hypoglycaemia, migraine etc which mimic TIA should be identified. TIA syndrome in carotid territory needs special evaluation by Duplex sonography to detect significant stenosis (>70%) near bifurcation. Recurrent TIA in the same territory leaves neuro deficit and this needs prevention by appropriate therapy (platelet antiaggregants, anticoagulants, surgical intervention). An algorithm listing initial workup for TIA is shown in Figure 1. Associated risk factors (e.g. high blood pressure, tobacco use, uncontrolled diabetes mellitus, high cholesterol level and obesity etc) need special emphasis. Lifestyle modification and lack of physical exercise cannot be ignored. In high risk group where TIA lasts longer than 10 minutes with significant neuro deficit in elderly subjects having diabetes or hypertension will need special attention and treatment. Diagnostic tests should include cardiovascular evaluation and ultrasound scanning of carotid arteries. Special neuroimaging tests like CT/MRI and CTA/MRA to visualize cerebral vasculature and detect asymptomatic lesions are helpful in planning long term management and prevention of stroke.