›BP targets in pregnancy
›Severe hypertension SBP >= 160 mmHg — treat immediately
›IV labetalol 20 mg bolus every 10 minutes up to 80 mg
›IV hydralazine 5 mg bolus every 20 minutes up to 20 mg
›Avoid ACE inhibitors and ARBs — teratogenic and fetotoxic
›Chronic HTN target in pregnancy SBP 110–160 mmHg
›Age-related differences in presentation
›Atypical presentations common in older adults
›Confusion, behavioral change, or fall as predominant presenting feature
›Mild or transient deficits dismissed as normal aging
›Higher prevalence of AF as cardioembolic source
›Paroxysmal AF underdiagnosed in older adults
›Lower threshold for prolonged cardiac monitoring
›Polypharmacy and drug interaction risks
›Antiplatelet bleeding risk assessment
›Concurrent NSAID, warfarin, or anticoagulant use
›Falls risk with DAPT — intracranial hemorrhage risk after falls
›Statin therapy in very elderly (age >80)
›Evidence supports high-intensity statin post-TIA regardless of age
›Monitoring for myopathy, hepatotoxicity, and drug interactions
›Clopidogrel and CYP2C19 polymorphisms
›Reduced clopidogrel efficacy in poor metabolizers
›Ticagrelor preferred if CYP2C19 poor metabolizer suspected
›Renal function considerations
›eGFR guides DOAC dosing if AF requires anticoagulation
›Apixaban dose reduction criteria based on age, weight, and creatinine
›Rivaroxaban dose reduction for CrCl 15–49 ml/min
›Dabigatran contraindicated if eGFR <30 ml/min
›Contrast for CTA — renal function check prior to imaging
›Cognitive and functional assessment
›Pre-existing dementia affects consent and follow-up reliability
›Caregiver involvement in discharge planning
›Cognitive decline as TIA complication separate from baseline
›Frailty assessment influences disposition
›Lower threshold for inpatient admission in frail older adults
›Early rehabilitation planning if motor or cognitive deficits
›Pediatric TIA — rare but important
›Incidence approximately 1.3–2 per 100,000 children per year
›Higher recurrence risk than in adults in some series
›Broader differential diagnosis than adult TIA
›Etiologies differ substantially from adults
›Sickle cell disease — most common identifiable cause in Black children
›Congenital heart disease — cardioembolic source
›Arterial dissection — trauma, connective tissue disorder
›Moyamoya disease — progressive intracranial arteriopathy
›Hypercoagulable states — antiphospholipid syndrome, protein C/S deficiency
›Imaging in children
›MRI with DWI preferred — no ionizing radiation
›Sedation often required in young children for MRI
›CT reserved for emergencies when MRI not available
›MRA head and neck for vascular evaluation
›Sickle cell — TCD screening essential; MRA for confirmed vasculopathy
›Antiplatelet therapy in children — weight-based dosing
›Aspirin 1–5 mg/kg per day (maximum 100 mg daily) — most commonly used
›Avoid Reye syndrome — confirm no active viral illness before starting
›Risk of Reye syndrome with viral illness and aspirin in children
›Clopidogrel — pediatric dosing limited evidence
›0.2 mg/kg per day for children — specialist guidance required
›Sickle cell disease — specific management
›Exchange transfusion for acute ischemic event
›Target HbS <30% post-transfusion
›Reduces immediate recurrence risk
›Chronic transfusion program for high TCD velocity (>200 cm/s)
›Reduces stroke risk by 90% in at-risk children
›Hydroxyurea as alternative to chronic transfusion in selected patients
›Pediatric neurology and hematology consultation mandatory
›Pediatric stroke team activation
›Comprehensive hypercoagulable and metabolic workup