Patient discussions

It is critical to emphasize the importance of immediate return to the emergency department if any new neurologic symptoms develop, and the time-critical nature of modern stroke therapy. Spontaneous resolution of TIA symptoms may lead symptoms of stroke to be ignored (in the belief that they, too, will resolve spontaneously). Patients and caregivers should be given an understanding of the most common symptoms of stroke such as unilateral weakness or loss of sensation, but also less commonly known presentations such as sudden vision loss, difficulty with speech, or sudden persistent vertigo.

All patients who have had TIA who are capable of physical exercise should be strongly advised to participate in at least moderate intensity aerobic activity for a minimum of 10 minutes 4 times a week or vigorous-intensity aerobic activity for a minimum of 20 minutes twice a week.[21] When this is not possible, the patient's physical goals should be customized to their exercise tolerance, stage of recovery, environment, available social support, physical activity preferences, and specific impairments, activity limitations, and participation restrictions. For those who sit for long periods of uninterrupted time during the day, it may be reasonable to recommend breaking up sedentary time with intervals as short as 3 minutes of standing or light exercise every 30 minutes for their cardiovascular health.[21]

In patients who are overweight or obese, weight loss is recommended.[21]

Smokers should be strongly advised to stop smoking.[21] Counseling with or without drug therapy (nicotine replacement, bupropion, or varenicline) is recommended to assist in stopping smoking. Avoidance of environmental (passive) tobacco smoke is also recommended.[21]

It is reasonable to counsel individuals to follow a Mediterranean-type diet, typically with emphasis on monounsaturated fat, plant-based foods, and fish consumption, with either high extra virgin olive oil or nut supplementation, in preference to a low-fat diet, to reduce risk of recurrent stroke.[21] For patients with stroke and hypertension who are not currently restricting their dietary sodium intake, it is reasonable to recommend that individuals reduce their sodium intake by at least 1 g/day (2.5 g/day salt) to reduce the risk of cardiovascular disease events (including stroke).[21]

Patients should be given individualized recommendations regarding high-risk activities such as driving, based on their early risk of second stroke.

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