|Case scenario 2|
|1.As symptoms have resolved there is no urgency in the assessment and management||2||30||0||Although the symptoms have resolved the risk of stroke remains significant. The ABCD2 score for this patient is 7 and would place him at high risk of a subsequent stroke. A score of 6 or 7 was found to have an 8.1 % risk of subsequent stroke in the following 48 hours .|
|2.Management in GP setting with CT before starting aspirin||20||9||3||The patient’s score is considered high risk, with the NSF recommending that a CT brain be performed within 24 hours .|
|Whilst the use of aspirin after a CT is recommended, a study of 9000 patients randomised to aspirin without CT found no significant excess haemorrhages, even in those who had an initial haemorrhagic stroke . However, in practice CT brain is performed prior to commencing aspirin.|
|Admission to an ASU would allow comprehensive monitoring and early access to treatment including thrombolysis if appropriate if this patient were to develop a subsequent stroke but the evidence remains unclear as to the best model of care.|
|3.Refer patient to neurology outpatients||7||20||4|
|4. Best practice would be to have him admitted to an Acute Stroke Unit (ASU).||16||7||9|
Mr DM is a 61 year old man who presents with a suspected TIA. His symptoms included weakness in his right arm yesterday, which resolved after 2 hours. He has a history of diabetes but has been managed on diet alone. He is an ex- smoker and his father had a stroke at 70 years. He has a history of hypertension for which he is on Perindopril 10 mg daily. His BP today is 150/68 and there are no significant neurological findings on examination.
Leung et al.
Leung et al. BMC Research Notes 2012 5:278 doi:10.1186/1756-0500-5-278