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Table 5 Case scenario 2

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.As symptoms have resolved there is no urgency in the assessment and management 2 30 0 Although the symptoms have resolved the risk of stroke remains significant. The ABCD2 score for this patient is 7 and would place him at high risk of a subsequent stroke. A score of 6 or 7 was found to have an 8.1 % risk of subsequent stroke in the following 48 hours [21].
2.Management in GP setting with CT before starting aspirin 20 9 3 The patient’s score is considered high risk, with the NSF recommending that a CT brain be performed within 24 hours [23].
Whilst the use of aspirin after a CT is recommended, a study of 9000 patients randomised to aspirin without CT found no significant excess haemorrhages, even in those who had an initial haemorrhagic stroke [25]. However, in practice CT brain is performed prior to commencing aspirin.
Admission to an ASU would allow comprehensive monitoring and early access to treatment including thrombolysis if appropriate if this patient were to develop a subsequent stroke but the evidence remains unclear as to the best model of care.
3.Refer patient to neurology outpatients 7 20 4
4. Best practice would be to have him admitted to an Acute Stroke Unit (ASU). 16 7 9
  1. Mr DM is a 61 year old man who presents with a suspected TIA. His symptoms included weakness in his right arm yesterday, which resolved after 2 hours. He has a history of diabetes but has been managed on diet alone. He is an ex- smoker and his father had a stroke at 70 years. He has a history of hypertension for which he is on Perindopril 10 mg daily. His BP today is 150/68 and there are no significant neurological findings on examination.