Ataque isquêmico transitório

Exame

Excluir a hipoglicemia como causa de sintomas neurológicos de início súbito.[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia [9]National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Apr 2022 [internet publication]. https://www.nice.org.uk/guidance/ng128

Se presente, trate a hipoglicemia com urgência e depois reavalie o paciente.

Exame

Excluir outras causas de sintomas neurológicos de início súbito (por exemplo, infecção).[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia

Exame

Para excluir a coagulopatia. Geralmente solicitado em pacientes com AIT quando o deficit neurológico persiste no momento da apresentação, caso a terapia trombolítica esteja sendo considerada.[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia

Exame

Como medida basal e para avaliar fatores de risco ateroscleróticos tratáveis.[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia

Exame

Excluir distúrbios eletrolíticos como causa de sintomas neurológicos de início súbito.[2]British Columbia Ministry of Health. Stroke and transient ischemic attack: acute and long-term management. April 2015 [internet publication]. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-tia

Exame

Solicite um ECG em todos os pacientes com suspeita de AIT para avaliar a fibrilação atrial e outras arritmias e descartar a isquemia miocárdica.[42]Royal College of Physicians; Scottish Intercollegiate Guidelines Network; Royal College of Physicians of Ireland. National clinical guidelines for stroke for the United Kingdom and Ireland. April 2023 [internet publication]. https://www.strokeguideline.org/app/uploads/2023/04/National-Clinical-Guideline-for-Stroke-2023.pdf

Em pessoas que seriam elegíveis para tratamento de prevenção secundária para fibrilação atrial ou vibração:[42]Royal College of Physicians; Scottish Intercollegiate Guidelines Network; Royal College of Physicians of Ireland. National clinical guidelines for stroke for the United Kingdom and Ireland. April 2023 [internet publication]. https://www.strokeguideline.org/app/uploads/2023/04/National-Clinical-Guideline-for-Stroke-2023.pdf

• Realize monitoramento prolongado de ECG (pelo menos 24 horas)

• Considere o monitoramento prolongado de ECG sequencial ou contínuo com um adesivo externo, gravador portátil ou loop event recorder implantável em pessoas nas quais nenhuma outra causa de AVC foi encontrada, especialmente se tiverem um padrão de isquemia cerebral em imagens cerebrais sugestivo de cardioembolismo.

Exame

Solicite uma tomografia computadorizada urgente da cabeça em pacientes que tomam um anticoagulante ou com um distúrbio hemorrágico para excluir hemorragia.[42]Royal College of Physicians; Scottish Intercollegiate Guidelines Network; Royal College of Physicians of Ireland. National clinical guidelines for stroke for the United Kingdom and Ireland. April 2023 [internet publication]. https://www.strokeguideline.org/app/uploads/2023/04/National-Clinical-Guideline-for-Stroke-2023.pdf ​

Não use tomografia computadorizada da cabeça em pacientes com suspeita de AIT, a menos que você suspeite de um diagnóstico alternativo que a TC possa detectar ou que eles estejam usando anticoagulantes.[9]National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Apr 2022 [internet publication]. https://www.nice.org.uk/guidance/ng128 [42]Royal College of Physicians; Scottish Intercollegiate Guidelines Network; Royal College of Physicians of Ireland. National clinical guidelines for stroke for the United Kingdom and Ireland. April 2023 [internet publication]. https://www.strokeguideline.org/app/uploads/2023/04/National-Clinical-Guideline-for-Stroke-2023.pdf