About stroke and tia
Stroke is the third leading cause of death in Ireland and the leading cause of acquired disability, but most strokes are preventable. High blood pressure, atrial fibrillation, diabetes, high cholesterol, smoking and inactivity are the main risk factors, and each can be treated.
Our clinic does two things: rapid assessment of suspected TIA and minor stroke once emergency care is complete, and follow-up of patients after a stroke, covering recovery, secondary prevention and the neurological problems that can follow, such as post-stroke pain, spasticity, seizures and cognitive change. Dr Raga Qasem has a specialist interest in stroke medicine.
Symptoms we assess
Stroke symptoms are an emergency: call 112 or 999. Reasons for clinic referral, once emergency assessment is done, include:
- A brief episode of weakness or numbness of the face, arm or leg on one side
- A brief episode of slurred speech, difficulty finding words or confusion
- Sudden loss of vision in one eye or of part of the visual field, now resolved
- Sudden dizziness with double vision or difficulty swallowing, now resolved
- A stroke or TIA that has not had specialist follow-up
- Questions about secondary prevention, driving or returning to work after stroke
- Late problems after stroke: pain, spasticity, seizures or memory change
How we diagnose it
For a suspected TIA the consultant takes the exact story of the episode, since migraine aura, seizures, faints and inner-ear vertigo can mimic TIA, and examines you for residual signs. Investigations are arranged urgently: MRI of the brain, imaging of the neck arteries (carotid ultrasound or CT angiography), an ECG and often prolonged heart monitoring for atrial fibrillation, an echocardiogram where indicated, and blood tests for cholesterol, glucose and clotting.
For stroke follow-up the consultant reviews the hospital investigations, checks that the cause has been identified and that every risk factor is treated to target, and assesses recovery and any new problems.
Treatment and follow-up
After a TIA or ischaemic stroke, treatment to prevent another starts immediately: antiplatelet medication, a statin, blood pressure control to target, and anticoagulation where atrial fibrillation is found. A narrowed carotid artery is referred for surgery within days where it is the cause. Smoking, diabetes and activity are addressed with specific support.
After a stroke, rehabilitation is coordinated with physiotherapy, occupational and speech therapy. Post-stroke problems have specific treatments: botulinum toxin for spasticity, medication for central post-stroke pain, anti-seizure medication where seizures occur, and assessment of mood and cognition. Driving rules after stroke and TIA are explained and documented.
The plan is shared with your GP, who manages the long-term risk factor control, and the consultant reviews you at intervals to confirm targets are met.
When to see a GP, and when to see a consultant
Any current stroke symptom, however brief, is an emergency: call 112 or 999 and go to an emergency department, where clot-busting treatment is time critical. Once assessed, or if an episode resolved days ago and was never assessed, ask your GP for an urgent neurology referral. Ask for a routine referral for stroke follow-up or for late complications.
