Should we see a specialist after Mom's TIA?

Luckyus3 asked...

My mother had a TIA 14 months ago. She is doing pretty well, but has not changed her diet and is not very active due to severe RA. She also is treated for high blood pressure.

My question is should she go beyond just seeing her family doctor occasionally and go to a cardiologist for check-ups about her TIA and ways to prevent another or would she need to see a neurologist?

Also, she does not sleep well at all and is on a lot of medications for various reasons.

Thank you.

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

In general, the evaluation of a TIA should include an examination of the arteries and the heart, as well as other risk factors. She should have imaging of the arteries (I personally prefer MR angiogram or CT angiogram over carotid ultrasound, as it gives a more thorough picture of all the arteries). Also, a heart evaluation with ultrasound of the heart and monitoring of the heart rhythm for 24 hours helps to eliminate the possibility that a clot could have come from the heart. Next, a check of cholesterol, and life style modification is warranted. Ideally, the "bad" cholesterol (LDL) should be less than 80, blood pressure should be less than 120/80, and the TIA victim should be encouraged to participate in exercise and healthy eating. Finally, with very few exceptions, anyone with a TIA should be started on an anti-platelet agent such as aspirin, Plavix, or Aggrenox.

If all of these things are being done, I don't think there is a need to see a Cardiologist. It probably makes sense to review her situation at least once with a Neurologist, if that has not been done.

Good luck!