Step II Difference between TIA and acute ischemic stroke? Got Uworld question wrong

[mjmdjd1]

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Hey guys I got a Uworld question wrong because the stem gave the description of a patient with acute ischemic stroke. The correct answer was TPA.

I unfortunately put clopidogrel because I thought it was TIA(although looking back, there was no mention of amaurosis fugax in the stem).

How do you guys separate TIA and acute ischemic stroke?

The way I'm rationalizing this right now is
1-3 hours following symptoms= Acute ischemic stroke, therefore use thrombolytics like TPA
Longer than 3 hours following symptoms+ amaurosis fugax= TIA, therefore use anti platelets/ clopidogrel or aspirin

 

[choc_mint]

TIA by definition is transient ischaemia attack. We can only diagnose TIA when there is resolution of neuro deficit symptoms within 24 hours after ruling out other possibilities.

In case of acute (active or ongoing) neuro deficit consistent with ischaemia (eg lateralization that is compatible with vascular territory), always assume it is an acute cva and treat as such until proven otherwise.

ETA: the thing is, symptoms of TIA generally are the same with acute stroke. TIA is like angina in CAD. While acute stroke is like MI.

Since they have essentially same sx, we can't risk not giving optimal therapy because we assume it is TIA and expect it to reverse.

 

[notbobtrustme]

focal neurologic deficits = stroke until proven otherwise. get a head ct to make sure he/she isn't bleeding into the brain then push tPA.

 

[bwmd]

focal neurologic deficits = stroke until proven otherwise. get a head ct to make sure he/she isn't bleeding into the brain then push tPA.

+ as long as it's still within the tPA window and there are no other contraindications