CUH ambulatory TIA Clinic
Patients with suspected TIA who:
Not suitable TIA clinic:
Those not suitable for discharge to the TIA clinic (as per proforma) include: High risk patients (should be admitted) with any one of:
- ABCD2 above 4 - these high score patients have a 1 in 9 chance of major disabling stroke within 6 days and most likely to occur within 24 hours.
- Known carotid stenosis
- Known AF
- More than one attack within the last month
- Residual symptoms or signs, not fully resolved
- Isolated dizziness
- Collapse with loss of consciousness or collapse query cause
- Had focal neurological symptoms lasting <24hrs
- Have already made a complete recovery with no residual signs
- Have no red flags for immediate AMAU/ED referral
- Have an ABCD2 score of 4 or below
are suitable for referral by their GP or EM staff. Fax a RASP TIA Referral proforma and list of medicines to 021 4920355. Please start these patients on aspirin on leaving the ED.
RASP suitable patients will be contacted and given an 8am appointment usually within 24-48 hours of referral.
Patients with high risk clinical features or ABCD2 of above 3 should be referred to AMU for medical admission.
The reason they should be admitted is that these patients are a ≈10% risk of completed/disabling recurrent stroke within 14 days, in contrast to those with low ABCD2 and no red flags.
Patients will have standardized investigations across the morning including blood tests, ECG, carotid imaging and brain imaging. They will be evaluated by the RASP (rapid-access stroke prevention) service and an urgent decision will be made regarding diagnosis, antithrombotic therapy and risk for recurrence.
There will be two slots per day.
TIA is a medical emergency with a 10% risk of stroke in the first 14 days. As this service is to be provided with no additional resources and with carotid and brain imaging it is essential that only patients with suspected TIA are referred to the Rapid Access service.
Dr Simon Cronin, Consultant Neurologist