Identification and management of difficult stroke and TIA syndromes

Usually, difficulty in the diagnosis and management of stroke occurs because of the rarity of the presentation, ignorance about the condition, or the lack of scientific clinical trial data to support clinical decisions. This article focuses on a very individual selection of topics, with much of the advice concerning management representing a personal view. It is not intended to be comprehensive, and is limited mainly to transient ischaemic attack (TIA) and ischaemic stroke. The importance of retaking a derailed history from thr patient and their carers or friends in difficult cases cannot be overemphasised. Radiological investigations should be reviewed, taking the history into account, and remembering that minor vascular abnormalities are common in the elderly and that optimum sequences may nor have been used, particular with magnetic resonance imaging (MRI). h lore extensive investigation map be required.