Stroke/transient ischaemic attack (TIA)

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

Acute neurological symptoms of a stroke; multiple/crescendo TIA
New acute symptoms of stroke/transient ischaemic attack (TIA)
Patients with acute neurological symptoms of a stroke within the past 7 days

Immediately contact on-call registrar or service to arrange an immediate neurology assessment (seen within 7 days) for:

To contact relevant service, please see HealthPathways: Acute Neurology Assessment

Presenting issues
Internal carotid stenosis (> 50%) with ongoing symptoms other than dizziness Asymptomatic internal carotid stenosis > 70% on imaging An old stroke identified on imaging that has not been previously addressed

Mandatory referral information (referral will be returned if this information is not included)
History Relevant history, onset and duration of symptoms including Evolution of symptoms Current medication list Relevant past medical history Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information) Examination Physical examination findings Investigations Doppler ultrasound carotid vessels Neuroimaging results ECG If unable to attach reports, please include relevant information/findings in the body of the referral Referrer to state reason if not able to attach mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Mandatory referral information (referral will be returned if this information is not included)

History

Relevant history, onset and duration of symptoms including
- Evolution of symptoms
Current medication list
Relevant past medical history
Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information)

Examination

Physical examination findings

Investigations

Doppler ultrasound carotid vessels
Neuroimaging results
ECG

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to attach mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
LFTs FBC Fasting lipids BGL Echocardiogram Holter monitor results ABCD2 stroke risk score Discharge summary (if the patient is being referred for second opinion) Indicate whether the patient has previously attended a neurology clinic or seen a neurologist If so please attach contact details, dates and any other information and correspondence relating to these visits

Highly desirable referral information

LFTs
FBC
Fasting lipids
BGL
Echocardiogram
Holter monitor results
ABCD2 stroke risk score
Discharge summary (if the patient is being referred for second opinion)
Indicate whether the patient has previously attended a neurology clinic or seen a neurologist
- If so please attach contact details, dates and any other information and correspondence relating to these visits

Indicative triage category

Indicative triage category
Category 1 Appointment within 30 days	No defined category 1 criteria
Category 2 Appointment within 90 days	Stroke/TIA known or suspected with last change in symptoms more than 2 weeks prior to referral
Category 3 Appointment within 365 days	Chronic ischaemic lesion identified on imaging not previously addressed

Last reviewed: 29-06-2023

Stroke/transient ischaemic attack (TIA)

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