TIA

Diagnosa

1. ANAMNESIS
 Recent surgery (eg, carotid or cardiac)
 Previous strokes or TIAs
 Seizures
 Systemic or central nervous system (CNS) infections
 Use of illicit drugs
 Complete medication regimen, including all overthecounter
medications
 Comorbidities related to metabolic disorders, especially diabetes
 Known coagulopathy or family history of early clotting or thrombotic
events
 History of arteritis
 Noninfectious necrotizing vasculitis, irradiation, and local trauma
 Thromboembolic risk factors (eg, carotid artery stenosis, venous or
arterial thromboembolism, patent foramen ovale or atrial septal defect,
atrial fibrillation, prior myocardial infarction, and left ventricular
dysfunction)
 Other known cardiovascular disease
 History of migraine
2. PEMERIKSAAN UMUM
A. Kesadaran Umum (GCS)
B. Initial vital signs should include the following:
 Temperature
 Blood pressure
 Heart rate and rhythm
 Respiratory rate and pattern
 Oxygen saturation
3. PEMERIKSAAN NUEROLOGIS
NHSS SCALE

4. PEMERIKSAAN IMAGING
A. CT-SCAN
 A new area of ischemia or infarction
 Old areas of ischemia
 Intracranial mass, such as tumor
 Intracranial bleeding, such as subdural hematoma or intracerebral
hemorrhage
B. MRI
 acute ischemia
 infarction
 previous intracranial bleeding
 other underlying lesions
 C. vasukular imaging
 carotid Doppler ultrasonography
 Transcranial Doppler ultrasonography
 CT angiography (CTA)
 Magnetic resonance angiography (MRA)
D. Cardiac Imaging and Monitoring
 TEE
 ECG
5. PEMERIKSAAN LABORATURIUM
A. Keadaan darurat
 Serum chemistry profile
 including creatinine
 Screening coagulation studies
 CBC
B. Keadaan gawat
 Erythrocyte sedimentation rate (ESR)
 Cardiac enzymes
 Lipid profile
 GDS

C. Tambahan
 Syphilis serology
 Antiphospholipid antibodies
 Toxicology screens
 Hemoglobin electrophoresis
 Serum protein electrophoresis
 Cerebrospinal fluid examination
 Protein C, protein S, and antithrombin III activities
 Activated protein C resistance/factor V Leiden
 Fibrinogen
 Ddimer
 Anticardiolipin antibody
 Lupus anticoagulant
 Homocysteine
 Prothrombin gene G20210A mutation
 Factor VIII
 Von Willebrand factor
 Plasminogen activator inhibitor1
 Endogenous tissue plasminogen activator activity
 Anticardiolipin antibody
 Lupus anticoagulant
 Homocysteine
 Prothrombin gene G20210A mutation
 Factor VIII
 Von Willebrand factor
 Plasminogen activator inhibitor1
 Endogenous tissue plasminogen activator activity
DD
 Carotid Artery Dissection
 Meningitis
 Meningococcal Meningitis
 Multiple Sclerosis
 Stroke, Hemorrhagic
 Stroke, Ischemic
 Subarachnoid Hemorrhage
 Subarachnoid Hemorrhage Surgery
 Syncope

Tatalaksana dan edukasi

medical
• Antithrombotic Therapy
o Atherothrombotic TIA: Daily long-term antiplatelet therapy: combination
extended-release
dipyridamole plus aspirin (reasonable as first choice), clopidogrel, or aspirin
alone.
Anticoagulation is not recommended
o Cardioembolic TIA: Long-term anticoagulation for atrial fibrillation
(continuous or
paroxysmal). If patient intolerant to anticoagulation, aspirin 325 mg daily;
clopidogrel 75 mg
daily if intolerant to aspirin.
• Hypertension: Lower blood pressure to <140/90 mm Hg or <130/80 mm Hg for
diabetics, with an
ACE inhibitor alone or in combination with a diuretic, or with an angiotensin-
receptor blocker
• Lipids: Initiate a daily statin. Goal LDL-cholesterol level <2.59 mmol/l
(<100mg/dl)
• Smoking: Initiate a cessation program
• Diabetes: Fasting blood glucose goal <126mg/dl
• Physical activity: Recommend ≥10 min of exercise such as walking, bicycling,
running, or
swimming ≥3 times/week

surgical
Carotid endarterectomy: Preferably within 2 weeks of cerebral or retinal TIA in
those with TIA
attributed to a high-grade internal carotid artery stenosis:
o 70-99% internal carotid artery stenosis: Recommended
o 50-69% stenosis: Recommended for certain patients and only at centers with
perioperative
complication rate <6%
o <50% stenosis: Not recommended
• Bypass surgery: Not recommended

Komplikasi Prognosis Tabel abcd