These forms, for use by GP's and medical practitioners in the community, are attached in PDF, Locked Word, Vision and EMIS format for immediate use. These have been designed in black and white to ensure they are fax friendly.
Please click on the links below to download each form:
Stroke risk following a TIA is greatest within the first 7 - 14 days
TIA DEFINITION
TIA is a clinical syndrome presenting as acute loss of focal cerebral or monocular function, due to inadequate cerebral or ocular blood supply, and lasting less than 24 hours.
CLINICAL FEATURES
More detailed information on identificatoin and diagnosis of TIA can be found on the RCP website
www.rcplondon.ac.uk or to download the 2008 National clinical guideline for diagnosis and initial management of acute stroke and transient attack (TIA) please click on the PDF icon
There may be no physical signs on examination so the gold standard to aid diagnosis is a thorough assessment by an experienced physician as soon as possible and an accurate and detailed history is vital
Common symptoms:
TIA symptoms are usually negative (i.e. 'loss of function')
Unilateral weakness, clumsiness, heaviness of one or both limbs or just hand
Unilateral sensory loss, numbness, tingling, 'dead'
Speech loss, dysarthria, dysphasia
Transient monocular blindness or blurring
|
Less common symptoms:
These symptoms do not normally present in isolation
Unsteadiness
Vertigo
Homonymous hemianopia
Diplopia
Bilateral limb weakness
|
Non Focal symptoms:
Faintness and dizziness are very rarely due to focal cerebral ischaemia, and are more likely due to syncope or non vascular causes (e.g. drugs)
|
Symptoms in isolation:
Inbalance
Simultaneous bilateral weakness
Slurred speech
Rotational vertigo
Double vision
A sensation of movement
|
SYMPTOM DURATION
Sensory symptoms lasting less than one minute are unlikely to support the diagnosis of TIA and the general view is that the minimum duration for a TIA is around 10 minutes. However symptoms of retinal ischaemia may be short lived.
In practice, most TIAs last less than an hour. Episodes lasting longer than this are unlikely to recover completely in 24 hours
SOME DIAGNOSITC CLUES:
TIAs largely negative symptoms
Good careful history essential to identify mimics:
Seizures - positive motor symptoms
Migraines - positive visual spectra
Tumours - stuttering onset and course
Syncope - non-focal (LoC)
REFERRAL FOR TIA PATIENTS:
RCP PRIMARY CARE CONCISE GUIDELINES FOR STROKE 2008
Consider any patient presenting with transient neurological symptoms of cerebrovascular nature to have had a TIA
All suspected TIAs require categorisation using ABCD2 criteria (see referral form for details) within 24 hours
All high risk (ABCD2 risk ≥ 4 or crescendo TIAs) should receive aspirin 300mg immediately and specialist assessment and investigation in 24 hours
USE OF THE REFERRAL FORMS
These forms should be completed as soon as possible and sent by fax to the preferred unit or clinic as outlined within the form.
By the time a patient who has potentially suffered a TIA presents to a medical professional it is likely that the symptoms have subsided. It is therefore essential to take a detailed clinical history. It is particularly useful to question a carer or relative who was there to witness the event.
The referral form includes the contact details of all Stroke units and TIA clinics for weekdays and out of hours services.
The form comprises:
Patient and GP details
FAST test
ABCD 2 test
Protocols for action to follow according to presentation and observations
Checklist
Contact details for Stroke Units and TIA clinics
Not all TIAs or Strokes are FAST positive, so if you think the diagnosis remains TIA or Stroke, still follow the protocol
FAST test
|
(Y/N) |
| FACE |
New unilateral weakness |
|
| ARM |
New unilateral weakness |
|
| SPEECH |
New speech disturbance |
|
Test is FAST positive when any of the features above are present.
Note: not all strokes/TIAs are FAST positive (e.g. patients presenting with ataxia, sensory distrubance or amaurosis fugax) so if you think the diagnosis remains TIA or Stroke, still carry on with the protocol. |
FAST will not pick up those with anterior ocular symptoms or posterior symptoms
| ABCD2 TEST |
Clinial Feature |
Category |
Score |
| A |
Age |
≥60
<60
|
1
0
|
| B |
BP on earliest assessment |
Systolic BP > 140mm Hg or Diastolic ≥ 90mm Hg
Other |
1
0 |
| C |
Clinical features |
Unilateral weakness
Speech distrubance
Other |
2
1
0 |
| D |
Duration |
≥ 60 mins
10 - 59 mins
< 10 mins |
2
1
0 |
| D |
Diabetes |
Present
Absent |
1
0 |
Total Score:
ABCD2 ≤ 3 = Low risk of early Stroke
ABCD2 ≥ 4 = High risk of early Stroke |
REFERRAL PATHWAY PROTOCOLS
Out of hours service runs from Friday 4pm to Monday 9am and includes Bank Holidays
THE PATIENT APPOINTMENT FORM
The patient appointment form can be downloaded to assist GPs in emphasising to the patient the importance of attending their TIA clinic appointment. The form contains a brief description of TIA and instructions for the patient. Please tick as appropriate whether the patient should attend their nearest TIA clinic within 24 hours (high risk) or 7 days (low risk). GPs can then select which of the 6 North West London TIA clinics the patient should attend.
This appointment form is designed to be filled out by the GP and given to the patient to be taken away with them.
Please note the TIA Referral form should still be filled out and faxed to the TIA clinic in the first instance.
