Dr. Walter Himmel and Dr. Daniel Selchen discuss the key historical and physical examination maneuvers to determine whether patients with neurologic complaints have had a TIA or whether they have had a TIA mimic. They review the 3 best risk stratification rules including the ABCD2 Score to help us determine who needs to be admitted and who needs timely investigations to reduce vascular morbidity and mortality. The reasoning behind which patients require urgent carotid imaging, echocardiograms and advanced imaging such as CT Angiogram is explained, and the best medication choices are reviewed, as well as the indications for Clopidogrel, Aggrenox, Warfarin, Heparin and carotid endarterectomy in the managment of TIAs. In the second part of the episode, a simple and practical approach to the patient with dizziness is presented, and a discussion on which patients with dizziness need urgent work-up and treatment for vertebrobasilar TIA.
In this episode Dr. Himmel and Dr. Selchen answer questions like: What simple things can we do in the ED for our TIA patients to improve cerebral blood flow? How do we manage blood pressure in the ED after a TIA? What are the limitations of the best stroke risk prediction rules after TIA? How can we differentiate the common TIA and stroke mimics from a true TIA or stroke in the ED? When is IV Heparin indicated for TIA? Why is carotid doppler imaging such an important test? Which patients need an urgent CT Angiogram or MR Angiogram? Which patients with TIA require admission? Which medication is better for stroke prevention after TIA, Clopidogrel or Aggrenox? How good is Warfarin at reducing the risk of stroke in patients with Atrial Fibrillation and TIA? Should we be prescribing antihypertensives for our patients who have had a TIA? When should we suspect carotid or vertebral artery dissection as a cause for TIA? How should we interpret the Dix-Hallpike manoeuvre and the Head-thrust test? How can we differentiate peripheral vs. central causes of vertigo at the bedside? What are the best medications for patients with vertigo? and many many more…..