When the patient fails to respond to treatment: TIAs that go on, and on
- Consultant Neurologist and Head of Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington Street, Perth, Australia 6001 ; gjhankey{at}cyllene.uwa.edu.au
Abstract
Most transient ischaemic attacks (TIAs) stop, with or without treatment, but some are followed by stroke within days or longer. But if the TIAs do not stop then the diagnosis must be reviewed (are they really TIAs or could they be migraine or epilepsy?), and if they are TIAs, what are they caused by (atherothromboembolism, embolism from the heart, etc)? With this information, both the medical and any surgical treatment can be optimised, even though one must accept that the randomised controlled trials mostly have not addressed the particular issue of continuing TIAs.
