FN: TIAs

Question 1

Definition

Answer 1

1. Sudden onset focal neurology lasting

Question 2

Signs

Answer 2

1. Symptoms usually brief
2. Global events (e.g. syncope, dizziness) are not typical
3. Signs mimic those of CVA in the same arterial territory

Question 3

Signs of Causes

Answer 3

Carotid bruits
raised BP
HEart murmur
AF

Question 4

Causes

Answer 4

1. Atherothromboembolism form carotids in main cause
2. Cardioembolism: post-MI, AF, valve disease
3. Hyperviscosity: polycythaemia, SCD, myeloma

Question 5

Differential

Answer 5

Vascular: CVA, migraine, GCA
Epilepsy
Hyperventilation
Hypoglycaemia

Question 6

Investigations

Answer 6

Aim to find cause and define vascular risk
bloods: FBC, U&E, ESR, glucose, lipids
CXR
ECG
Echo
Carotid doppler ± angiography
Consider brain imaging - diffusion weighted MRI is best

Question 7

Management

Answer 7

ACAS

1. Time to intervention is crucial
   a. intervention w/i 72hrs - 2% strokes @ 90d
   b. Intervention w/i 3 wks - 10% strokes @ 90d
2. Avoid driving

Question 8

Medical treatment

Answer 8

Antiplatelet therapy/Anticoagulate

1. Aspirin/clopi 300mg/d for 2 wks then 75mg
2. Warfarin if cardiac emboli: AF, MI, MS - after 2 weeks

Question 9

Cardiac risk factor control

Answer 9

BP, lipids, DM, smoking
Excercise
Diet: reduce salt

Question 10

Assess risk of subseqeunt stroke

Answer 10

ABCD2 score

Question 11

Specialist referral to TIA clinic

Answer 11

ABCD2 >4 w.i 24 hrs

ABCD2

Question 12

Carotidendarerectomy

Answer 12

1. beneficial if >70% symptomatic stenosis

2. 50-70% stenosis may benefit if operative risk is

Question 13

Prognosis

Answer 13

Combined risk of stroke and MI is 9% yr

3x raise in mortality cf TIA-free populations

Question 14

ABCD2 Score

Answer 14

Age >60
BP >140/90
Clinical features
a. Unilateral weakness (2 points)
b. Speech disturbance w/o weakness
Duration >1h (2 points)
10-59 min
DM