Neurology
TIA & Ischemic Stroke
Neurology

TIA & Ischemic Stroke

TIA = warning; ischemic stroke window 4.5 h for tPA, 24 h for thrombectomy.

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◆TIA

  • •Focal neuro dysfunction <24 hr, no infarction on imaging
  • •Warning for future stroke — secondary prevention: BP control + high-intensity statin + antiplatelet (ASA)
  • •tPA NOT indicated for TIA
  • •Amaurosis fugax = retinal TIA → carotid duplex US

◆Ischemic stroke

  • •Strongest modifiable risk factor: HYPERTENSION; non-modifiable: AGE
  • •Other risks: smoking, DM, hyperlipidemia
  • •Embolic: AFib (LAA thrombus), post-MI ventricular aneurysm
  • •Lacunar: small vessel HTN damage in basal ganglia/putamen → pure motor, pure sensory, dysarthria-clumsy hand

◆Management

  • •Non-contrast CT FIRST to exclude hemorrhage
  • •tPA (alteplase) if <4.5 hr from LKW + no contraindications
  • •Thrombectomy up to 24 hr with favorable imaging (DAWN/DEFUSE-3)
  • •BP <185/110 before tPA, <180/105 for 24 hr after
  • •>4.5 hr or ineligible → aspirin; permissive HTN (treat only if >220/120)
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