Transient Ischemic Attack Medical Slides

Present the EXPRESS study (2007): rapid TIA clinic evaluation within 24 hours reduced 90-day stroke risk by 80% compared to standard referral. Emphasize the "TIA is a stroke warning" paradigm — 15-20% of strokes are preceded by TIA, and the highest risk period is the first 48 hours. Teach that DWI-positive "TIA" (30-50% of cases) has equivalent stroke risk to completed stroke and should be managed as such.

Reference the CHANCE trial (2013, 21-day ASA + clopidogrel vs ASA alone in minor stroke/TIA) showing 32% relative risk reduction, and POINT trial (2018, 90-day course) showing benefit at 90 days but increased bleeding after day 21. Current AHA/ASA recommendation: dual antiplatelet (ASA + clopidogrel) for 21 days followed by single agent in high-risk TIA (ABCD2 ≥4) or minor ischemic stroke (NIHSS ≤3). CYP2C19 genotyping guides clopidogrel substitution with ticagrelor.

Present the cardiac workup hierarchy: (1) 12-lead ECG for AF (found in 5-10% acutely), (2) continuous cardiac monitoring for ≥24 hours (detects paroxysmal AF in additional 5%), (3) extended cardiac monitoring for 30 days with implantable loop recorder in cryptogenic TIA (CRYSTAL-AF found AF in 30% at 3 years), (4) echocardiography (TTE initially, TEE if PFO or intracardiac source suspected). This systematic approach prevents missing AF, which changes anticoagulation strategy entirely.