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Table 2 Case scenario 1a

From: Transient Ischaemic Attack (TIA) Knowledge in General Practice: a cross-sectional study of Western Adelaide general practitioners

  True False Unsure Evidence
n n n   
1.She may have had a TIA 32 0 0 At the time of the study a TIA was defined as a sudden focal loss of neurologic function with complete recovery usually within 24 hours [16].The National Institutes of Health (NIH) committee on the Classification of Cerebrovascular Disease defined the time based definition of TIA. In 1965 the arbitrary 24-hour time limit definition was adopted, in a setting where there was limited imaging or treatments for stroke [17]. A tissue based definition has been adopted since, with TIA now being a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction [18].
2.She may have had a stroke 7 21 3
3.A normal CT brain excludes a stroke 8 23 0 An early CT scan (within the first few hours) may be normal in ischaemic stroke. However, with experienced observers in up to 50 % of cases abnormalities can be seen on CT scan within 5 hours [19].
4.The differential diagnosis would include radiculopathy, cervical myelopathy or an intracranial pathology (e.g. tumour) 23 4 4 The diagnosis of TIA is clinical and can be challenging. The inter-observer diagnosis of TIAs even amongst neurologists has been reported to be poor [10]. The possible list of differential diagnoses can be extensive, ranging from significant neurological disorders to somatisation disorder.
  1. Mrs JM, a 65 year old lady, presents with a history of tingling in her left arm and left leg whilst she was on holidays 2 weeks ago in Queensland. She smokes 8 cigarettes a day and is on Indapamide 2.5 mg daily for her hypertension. Her symptoms which lasted for about an hour resolved completely, and she thought that it was the hot weather that triggered it. Her BP today is 170/90. She is not a diabetic and her recent (total) cholesterol 7.9 mmol/L.