Aktuelle Neurologie 2009; 36 - P706
DOI: 10.1055/s-0029-1238799

Outpatient TIA clinic for patients with suspected transient ischaemic neurological attack – first experiences from the TIA clinic Harlaching

S Hörer 1, S Kirsch 1, R Haberl 1
  • 1München

Background: Early diagnostic evaluation of TIA is warranted, since rapid initialization of secondary prophylaxis can reduce the risk of stroke after TIA significantly. The TIA clinic should provide diagnostic evaluation, stratification of stroke risk, and decision-making within less than one day.

Methods: The TIA clinic provides a stroke work-up with cerebral MRI (DWI, FLAIR, FFE, TOF angio), duplexsonography of extracranial arteries, TCD-PFO-screening, ECG and blood tests. According to ABCD_2 Score, Essen Stroke Risk Score (ESRS), and ancle-brachial-index (ABI), secondary stroke prophylaxis is initialized or the patient is referred to the stroke unit.

Results: Thirty patients were seen from February to March, 2009. Among them, there were 7 TIAs (23,3%), 3 strokes (10%), 6 migraines with aura (20%), 1 transient global amnesia (3,3%), 1 Menière's disease (3,3%), 1 BPPV (3,3%), 2 suspected focal seizures (6,6%), and 8 other diagnoses (26,7%). Median time from symptom onset to admission was 48h (range 1h to 6 weeks), median duration of symptoms was 30min (range 1min to 6 weeks). Mean ABCD_2 score was 2,4±1,3, mean ESRS 1,3±1,4, mean ABI 1,0±0,1. Twenty nine patients (97%) were sent home the same day. One patient with symptomatic ACI stenosis (ABCD_2 score 5, ESRS 3) was referred to the stroke unit and received urgent carotid revascularization. TIA patients received ASS 300mg immediately. Stroke secondary prophylaxis, and in some cases additional diagnostic work-up was recommended to the GP according to the individual cardiovascular risk profile.

Conclusion: An urgent stroke work-up can confirm the diagnosis of TIA within one day on an ambulatory basis. Many of the referred patients do not have a TIA, but another transient neurological attack. TIA patients at high risk for acute stroke can be identified by stroke risk scores and admitted to the stroke unit. Most patients are discharged home the same day.