Episode 6: Transient Ischemic Attack

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 2 July 2010

⏱️ 123 minutes

🔗️ Recording | iTunes | RSS

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Summary

Transient Ischemic Attack (TIA) can be difficult to diagnose. It's unclear who to work up. It's challenging if the patient is already taking blood thinners. Dr. Walter Himmel and Dr. Daniel Selchen discuss the key historical and physical examination maneuvers to determine whether patients with neurologic complaints have had a TIA or whether they have had a TIA mimic. They review the 3 best risk stratification rules including the ABCD2 Score to help us determine who needs to be admitted and who needs timely investigations to reduce vascular morbidity and mortality. The reasoning behind which patients require urgent carotid imaging, echocardiograms and advanced imaging such as CT Angiogram is explained, and the best medication choices are reviewed, as well as the indications for Clopidogrel, Aggrenox, Warfarin, Heparin and carotid endarterectomy in the managment of Transient Ischemic Attack. In the second part of the episode, a simple and practical approach to the patient with dizziness is presented, and a discussion on which patients with dizziness need urgent work-up and treatment for vertebrobasilar TIA.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's
0:10.8	brightest minds in emergency medicine from EMC Studios in Toronto.
0:20.2	On this sixth episode of Emergency Medicine, we have Dr. Walter Himmel and Dr. Daniel
0:25.6	Selchin. Dr. Himmel is an emergency physician in North York General Hospital, Scarborough General
0:30.2	and Toronto East General Hospitals. He is a world-renowned speaker in emergency medicine
0:34.7	and a recipient of multiple teaching awards. Dr. Daniel Selchin is a
0:38.8	neurologist and a Rhodes Scholar. He is the head of the Division of Neurology and the Regional
0:43.8	Stroke Program at St. Michael's Hospital in Toronto. He was the medical director of the West
0:48.7	Greater Toronto Area Stroke Center from 2001 to 2008 and is a researcher in stroke and TIA.
0:56.1	The classic definition of a TIA is neurologic dysfunction caused by focal brain or retinal
1:02.6	ischemia lasting less than 24 hours. And this 24 hours came about sort of arbitrarily.
1:10.5	It was kind of pulled out of nowhere.
1:12.6	Recently, the definition has changed of TIA to less than one hour because they found that up to
1:19.3	about 50% of classically defined TIAs that is scheming within 24 hours were actually
1:25.5	infarcs as shown on MRI.
1:35.3	Today, we're going to discuss the importance of recognizing TIA and facilitating appropriate workup and treatment in a timely manner. Why should we care? Well, strokes are the third biggest
1:41.6	killer of any disease and once a patient has a stroke, even with thrombolysis, there's often devastating long-term disability.
1:48.7	About a quarter of strokes are preceded by a TIA, and up to 15% of patients have a stroke within three months of a TIA, with half of those occurring within the first 48 hours.
2:00.5	So this is something that emergency doctors really should be caring about.
2:04.6	You might be thinking, well, we can't really do much for patients with TIA anyways, so why does it really matter?
2:11.6	Well, it does matter because some of the medications and surgical interventions have been proven to significantly affect outcomes,
2:19.3	and these are all time sensitive.
	...

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