TIA

Question 1

def tIA

Answer 1

ischemic (usually embolic) neurological event with symptoms <24h (often much shorter)

Question 2

aetiology TIA

Answer 2

causes of stroke

atherothromboembolism from carotid - listen for bruits (not sensitive)

cardioembolism - mural thrombus post-MI or in AF, valve diseae, prosthetci valve

hyperviscosity - eg polycythaemia, sickle cell anaemia, myeloma

vasculitis - rare, non embolic cause eg cranial arteritis, PAN, SLE, syphilis

RF

AF

valvular disease

carotid stenosis

congestive HF

HTN

dm

cigarette

alcohol use disorder

age

Question 3

epi TIA

Answer 3

Each year in England 2000 people have a first episode of TIA.

age-adjusted annual incidence rate for TIA in the UK has been estimated at 190 cases per 100,000 population

Question 4

sx TIA

Answer 4

amaurosis fugax - retinal artery occluded = unilateral progressive vision loss - like a curtain descending

sudden onset and brief duration of symptoms (minutes)

neurological deficit

global events ge syncope/dizziness - not typical of TIAs

attacks maybe single or many - multiple highly stereotyped attacks (‘crescendo TIAs) - suggest a critical intracranial stenosis - commonly superior division of MCA

unilateral weakness or paralysis

dysphasia

ataxia, vertigo, loss of balance

homonymous hemianopia

diplopia

Question 5

Ix TIA

Answer 5

• FBC
• UE
• ESR
• glucose
• lipids
• CXR
• ECG
• carotid doppler +- angiography
• CT or diffusion-weighted MRI
• echo

Question 6

mx TIA

Answer 6

control CVS RF - optimise BP (cautiously lower - aim for <140/85), hyperlipidaemia, dm, smoking

antiplatelet drugs - aspirin 300mg OD for 2wks, then switch to clopidogrel 75mg OD - if CI or not tolerated aspirin 75mg OD combined with slow release dipyridamole

anticoagulation indications - cardiac source of emboli

carotid endarterectomy - in 2wk of 1st presentation if 10-99% stenosis and operative riskm acceptable (higher risk in female >70, high SBP, contralateral artery occluded, ipsilateral carotid syphon/external carotid stenosed). Don’t stop aspirin pre-op

Surgery is preferred to endovascular carotid artery angioplasty with stenting in those fit enough - higher peri-procedure stroke and mortality rates with stenting.

Question 7

complications TIA

Answer 7

stroke

MI

Question 8

Px TIA

Answer 8

Without intervention, more than 1 in 12 patients will go on to have a stroke within a week, so prompt management is imperative

CVS events

dependent on underlying vascular RF - calculate with ABCD2 score

other factors that increase risk: AF, >1 TIA in a wk, TIA while anticoagulated

risk lowest if pt treated in specialised stroke unit

Question 9

ABCD2 score:

Answer 9

• Age >=60 (1 point)
• BP >=140/90 (1)
• Clinical features (unilateral weakness -2, speech disturbance w/o weakness - 1)
• Duration of symptoms >=1hr = 2, <1hr = 1
• DM - 1

score >=4 = high risk of early stroke - must be assed by unit in <24hr

>=6 - strongly predicts stroke