Transient Ischemic Attack

Transient Ischemic Attack Cerebral or retinal symptoms consistent with transient ischemic attack (TIA) usually last for seconds or minutes and typically last less than 1 hour. A suspected TIA should be evaluated urgently in a TIA clinic or in an emergency department where appropriate specialist expertise and imaging are available. Diffusion-weighted imaging of the head is now the preferred test for patients with a suspected TIA and should be performed immediately. If possible, immediately after the onset of symptoms, the patient should take aspirin at a dose of 300 mg, followed by 75 to 100 mg daily; clopidogrel should be added to aspirin during the first 21 days after the TIA (at a 300-mg loading dose, followed by 75 mg per day). The long-term prevention of stroke after TIA typically includes antiplatelet or anticoagulant treatment (depending on etiologic findings), blood-pressure lowering, lipid lowering, glycemic control, smoking cessation, and counseling regarding diet and lifestyle. Carotid endarterectomy should be performed if appropriate. A suspected transient ischemic attack should be evaluated urgently in a clinical setting where appropriate specialist expertise and imaging (ideally diffusion-weighted imaging) are available. Management typically includes aspirin (immediately and indefinitely, with clopidogrel for the first 21 days), evaluation to identify the cause and guide intervention as appropriate, and control of risk factors.