After a stroke or a transient ischaemic attack, the priority shifts to one question: why did it happen, and how do we prevent the next one?
A transient ischaemic attack is a warning shot. Symptoms resolve, often within minutes, and because nothing seems to be left behind many people never follow up. The risk of a completed stroke in the days and weeks after a TIA is substantial, and it is also highly modifiable — which makes this one of the highest-yield visits in all of neurology.
The work is to find the mechanism. A stroke caused by atrial fibrillation calls for anticoagulation; one caused by carotid stenosis may call for a procedure; one caused by small-vessel disease calls for aggressive blood pressure and lipid control. Treating all three the same way leaves patients exposed.
For patients recovering from a completed stroke, we manage the neurological aftermath that often goes unaddressed — spasticity, post-stroke pain, fatigue, mood change and seizures — alongside prevention and coordination with rehabilitation.
Use BE-FAST: sudden Balance loss, Eye or vision change, Face drooping, Arm weakness, Speech difficulty — Time to call 911. Do not drive yourself and do not wait to see whether it passes. Treatment that restores blood flow is only available within a narrow window.
“A TIA is the most valuable warning a patient will ever get. Almost every stroke that follows one was preventable.”