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Stroke and transient ischaemic attack (TIA) is the sudden onset of focal neurological dysfunction of presumed vascular origin. With a TIA this resolves within 24 hours (usually much sooner), whereas with a Stroke this persists beyond 24 hours.
Transient ischaemic attack (TIA) is the sudden onset of focal neurological dysfunction of presumed vascular origin that, by definition, resolves within 24 hours (usually much sooner). People who have had a suspected TIA may be at high risk of stroke if their symptoms are due to cerebrovascular disease i.e. if they have had a TIA.
Consider the appropriateness of a TIA referral carefully. About 50% of patients referred as suspected TIAs turn out to have an alternative diagnosis. Patients whose symptoms are not typical of a TIA or stroke may have their risk category downgraded during triage, at the discretion of stroke physicians.
What is not a TIA?
The following are unlikely to be due to a TIA:
The following, if isolated, are also unusual - vertigo, tinnitus, dysphagia, dysarthria, diplopia, ataxia.
If YES to any of the following features at onset, the diagnosis of TIA is unlikely and an appropriate alternative referral pathway should be used e.g. syncope clinic:
ABCD2 score is no longer recommended to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA
If patients have symptoms for which there is a strong clinical suspicion of a TIA, they should be referred to the TIA Assessment Service. The following factors will increase the urgency of referral to the TIA Assessment Service and put patients at a high risk of stroke:
Any suspected TIA (bearing in mind that their symptoms must be compatible with a TIA) should be treated with:
Advise all patients to:
In the event of a likely stroke – bluelight patient to Gloucester Royal Hospital (GRH) Emergency Department, up to 24 hours from onset.
If delayed presentation, admit to GRH in most instances, particularly if there are persistent/ ongoing symptoms and if they are not improving. An admission for confirmation of the diagnosis and therapy reviews and rehabilitation will be helpful. However, non-disabling strokes where the patient is safe at home, has no dysphagia and is improving may be referred to TIA clinic which is an efficient way of assessing and investigating such patients.
All clear TIAs should be reviewed in a TIA clinic within 24hrs, where possible. Clinic slots are available at weekends for high risk patients.
Where a second opinion is needed about a suspected TIA, they will be reviewed in a TIA clinic review as soon as possible. Situations where lower priority may be given include:
Please see the Services & Referrals section for details on how to refer.
TIA services are based at Gloucestershire Royal Hospital (GRH). Clinics run from 1.30pm Monday - Friday and on weekend mornings (for high risk patients only)
Acute stroke services are located at Gloucester Royal Hospital providing 24/7 cover. This is run by 4 consultants and stroke specialist nurses
A thrombectomy service has been developed in Southmead Hospital for intra-arterial clot extraction for certain patients with acute ischaemic stroke – currently patients come to their local emergency department (i.e. GRH) and are then assessed and transferred if appropriate
Community based Early Supported Discharge is available 7/7
Community Stroke Nurse Service is available weekdays only
Please see the Services and Referrals Section for further information and contact details.
Follow up care
Typically 6-8 weeks for first Out Patient assessment (not if patients are on end of life care or severely disabled and discharged to nursing homes).
Some patients need further secondary care appointments for specific issues e.g. spasticity management.
Six month follow up by community stroke coordinators (see below).
Community Stroke Co-ordinator Service
The service provides:
The team receive referrals from the acute hospitals, community and primary care services, please see the referral form.
Please follow this link for further information.
Early Supported Discharge Team
The Early Supported Discharge (ESD) team are based in the community and provide intensive rehabilitation for stroke patients at their place of residence for up to 6 weeks. The team consists of occupational therapists, physiotherapists, speech and language therapists, rehabilitation assistants, community stroke co-ordinators, administration assistants and psychologists. Referrals are received through the acute stroke units at GRH.
Primary Care Management