Focal symptoms/signs include:

• Unilateral motor disturbance
• Unilateral sensory disturbance
• Dysarthria
• Dysphasia
• Visual field defect
• Monocular visual loss
• Posterior circulation - ataxia, vertigo, nystagmus

Transient loss of consciousness is almost never caused by TIA or stroke - consider referral to cardiology or neurology.

Urgent assessment is required for:

• Symptoms/signs of stroke which have lasted longer than 4 hours at presentation and are ongoing
• Symptoms/signs which were present on waking and are ongoing
• Patients with symptoms/signs and on anticoagulant therapy or with a known bleeding disorder

Arrange urgent assessment:

• Within the hours of 9-5, Monday to Friday, please phone DGRI switchboard and ask to speak to the stroke team or direct dial 01387 241019.
• Outside of these hours, please refer to the on call medical team.

Advice will be given about the need for admission or review at stroke clinic.

For symptoms/signs which have lasted a few hours or less and have completely resolved:

Refer to the urgent neuro-vascular clinic by:

• Telephoning DGRI switchboard and asking for the stroke team or direct dial 01387 241019, and
• Sending a SCI-Gateway referral - DGRI...General medicine - Stroke...DG-HN Neuro-vascular RAC

Note there is no need to complete the ABCD2 assessment tool; it is no longer used.

Phoning the stroke line as well as doing a SCI referral allows the team to give tailored interim treatment advice, advise when admission may be more appropriate and facilitates more rapid booking of clinic slots.

Interim treatment

While waiting for a clinic appointment:

• Commence antiplatelet - 300mg loading dose of Clopidogrel and then 75mg daily or same doses of aspirin if Clopidogrel contra-indicated.
• Commence Atorvastatin 40mg daily.
• Advise patient not to drive until seen at clinic.
• It is helpful if you can take blood for U&E, TFT, HbA1c, Lipids, FBC (and ESR if monocular visual loss) then results will be available in the clinic.

Neuro-vascular clinics

Clinics are at DGRI, on Monday, Tuesday and Thursday afternoons 

These clinics offer a specialist assessment with same day ECG, CT brain and carotid scanning. They also have access to MRI and 3 day ECG monitors.

A letter detailing the diagnosis, medication changes, investigation results (for on the day tests) and follow-up will be sent to both the referring team and to the patient.

If further investigations are requested, a letter detailing results will be sent promptly to the referring team and to the patient.

Most patients diagnosed with TIA or stroke will be followed up by one of our specialist stroke nurses at their clinics, either face-to-face or by telephone.

Resources

Chest, Heart and Stroke Scotland offer good online support resources.