Transient Ischemic Attack: The Daily PANCE Blueprint
An 80-year-old female smoker with a history of T2DM presents to the ER complaining of right-sided weakness for three hours, which has now resolved. CT head is unremarkable. Which of the following is the best treatment for the most likely diagnosis?
A. Emergent IR consultation
B. Intravenous thrombolytics
C. Antiplatelets and lifestyle management
D. High-intensity statin alone
E. Reversal of any anticoagulation
Answer and topic summary
The answer is C. Antiplatelets and lifestyle management
The patient had a transient ischemic attack (TIA), which is characterized by transient neurological symptoms without objective evidence of an actual acute infarction. Symptoms depend on what artery is impacted, but patients may have sudden hemiparesis, hemiplegia, aphasia, or transient vision loss. Risk factors include hypertension, smoking, alcohol, diabetes, illicit drug use, and atrial fibrillation.
Urgent evaluation is needed in patients with symptoms of TIA (e.g., CT or MRI head, CTA, or MRA of the head/neck, echocardiogram, and lab studies like PT/INR, etc). It’s important to realize that the risk of a stroke after a TIA is 2-17% in the following 90 days. The ABCD2 score is used to determine the stroke risk following a TIA: age > 60 years, SBP > 140 or DBP > 90, unilateral weakness or speech impairment, diabetes, duration of TIA. Treatment for most (high-risk) patients include dual antiplatelet therapy (ASA + clopidogrel) for 21 days and risk factor management (statin, exercise, etc).
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ Cerebrovascular Disorders ⇒
Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and Emergency Medicine EOR topic list
