EM Cases · Transient ischaemic attack
High-risk TIA — the secondary prevention station
ACEM Fellowship clinical station testing tissue-based TIA definition, glucose-first rule, ABCD2, DAPT 21 days, and time-critical carotid assessment.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
Resolved focal deficit with high ABCD2, carotid bruit and the need for urgent imaging and prevention — not false reassurance.
Station brief
Format. Clinical-management station, 11 minutes total — 4 minutes reading, 7 minutes active assessment. You are the Emergency Medicine consultant.
Candidate instructions. Assess and manage. State actions and reasoning aloud. The examiner plays nursing and laboratory staff.[1]
References6ShowHide
- [1]Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council. Stroke, 2009.PMID 19423857
- [2]Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet, 2007.PMID 17258668
- [3]Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study). Lancet, 2007.PMID 17928046
- [4]Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack (CHANCE). N Engl J Med, 2013.PMID 23803136
- [5]Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA (POINT). N Engl J Med, 2018.PMID 29766750
- [7]Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet, 2003.PMID 12531577