Acute treatment of TIA and

Knowledge of the anatomy of the blood supply of the brain is often helpful in understanding the etiology and mechanisms of TIA and stroke, which enable accurate targeting of acute treatment and secondary prevention. An awareness of the mechanisms underpinning the regulation of cerebral blood flow allows the clinician to identify patients at risk of stroke and assess the possible effects of treatments. 

Elevated blood pressure is common after ischemic stroke, and its treatment is associated with a decreased risk of stroke recurrence. The Joint National Committee and AHA/ASA guidelines recommend an angiotensin-converting enzyme inhibitor and a diuretic for reduction of blood pressure in patients with stroke or TIA after the acute period (first 7 days). Angiotensin II receptor blockers have also been shown to reduce the risk of stroke and should be considered in patients unable to tolerate angiotensinconverting enzyme inhibitors after acute ischemic stroke. 

This chapter will summarize the aspects of acute treatment that are specific to TIA and minor stroke. 

The REACH system in southern Georgia (United States) and the TEMPiS system in Germany reported decreased latency to rt-PA delivery on a larger scale. REACH system investigators reported 194 acute stroke consultations dehvered via telemedicine. The time from symptom onset to rt-PA delivery decreased from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients of 30 patients treated with rt-PA, 23% were treated in 90 minutes or less and 60% were treated within 2 hours without any incidence of post-treatment symptomatic intracerebral hemorrhage. In 2004, the second year of the TEMPiS system, 115 patients in telemedicine-networked community hospitals and 110 patients in stroke centers received rt-PA for acute ischemic stroke or TIA. Patients treated at networked community... 

Due to the narrow time window available for the initiation of thrombolytic treatment, speed is of the essence. The rationale in the work up for acute stroke is, therefore, to identify as quickly as possible those patients who may benefit from lA or IV thrombolysis or other available acute stroke therapies. Importantly, CTA excludes from treatment patients with occlusive stroke mimics (e.g., transient ischemic attack [TIA], complex migraine, seizure) who will not benefit from, and may be harmed by, such therapies. 

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