Jump to content
Sign in to follow this  

TIA - what do they get in your hospital or practice? What should they get?

Recommended Posts

I am very curious for some insight here.  A patient presents with TIA, symptoms resolve in less than 1 hour, and let's just say were witnessed, believable, but not present on arrival to the ED.  ABCD2 score is 3 or 4.  This is just a hypothetical case.  The patient has a couple comorbidities, let's say mild HLD and HTN, but nothing too exciting.  The head CT comes back negative, and blood work including PT/PTT are unremarkable.  An EKG is totally normal and there are no indications of heart disease.  What happens next in your department, what do you think should happen?

 

Does everyone get admitted?  An MRI?  An MRA?  A 2D echo?  Antibody blood work?  Formal neurology consult?  Run of the mill carotid doppler or are these extracranial vessels being worked up via MR or CT?  Also, if lipids are normal, are they going on statin therapy nevertheless, like their CVA counterparts?

 

Very grateful for anyone's advice, opinions and such.

Share this post


Link to post
Share on other sites

I try to admit no matter what, and order the carotid us tomorrow. Echo if any indication of arrhythmia with EKG/monitoring. Nursing neurons checks with vitals every 4. Neurology consult? I sometimes talk to a such unicorns on the phone, but the static from 200 mile usually interferes. The rest of it is up to the hospiralist to figure out.

 

I admit them so that if they have the big MCA stroke then they are quickly identified and thrombolized....and to get someone else's name on discharge!

Share this post


Link to post
Share on other sites

I work as a Neurology PA in Denver, and we have our own "TIA Clinic". This provides a full neurology workup without admitting the patient to the hospital. What typically happens is that we (a majority of the time) get a call from the ED regarding a potential TIA case. Over the telephone, depending on the situation, we recommend certain tests (for instance a plain brain MRI) and if WNL will d/c home and schedule a TIA clnic appointment.

 

This "clinic" is essentially an area of the hospital the patient comes in first thing in the morning (prefer to have them here within 48 hours of symptoms), and get the full stroke workup. This includes (if not done already) an MRI of the brain, vascular imaging (typically MRA or CTA Head/Neck) or a carotid ultrasound depending on the case, Echocardiogram with bubble study, and fasting lipid panel. We then see them as a formal neurological consult that same day and go over the results. I think every potential TIA patient should get a neurological evaluation and workup within this time window. We then may add some additional testing such as a hypercoag panel, heart monitoring (48 hour holter, 30 day express afib monitor, etc...), or other recommendations. We will then sometimes see them in clinic in follow up.

 

Many times PCP offices can refer to our TIA clinic if symptoms have occurred more than 24 hours ago. For instance, patient comes in on Monday with what sounds like a TIA on Saturday night. Patient is clinically stable without any issues, he will recommend TIA clinic workup the next day. No need to utilize the emergency department or warrant admission to an otherwise stable patient. Saves $$$ and the patient gets a full workup quickly.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More