TIA

Question 1

What are the 3 group of causes of a TIA?

Answer 1

1. Atherothromboembolism
2. Cardioembolism
3. Hyperviscosity
4. Vasculitis can cause TIA symptoms

Question 2

Why might you have atherothromboembolism?

Answer 2

from carotid (listen for bruits)

Question 3

What are cardioembolism causes of TIA?

Answer 3

1. post MI
2. AF
3. valve disease

Question 4

What are hyperviscosity cause of TIA?

Answer 4

1. polycythaemia
2. sickle cell anaemia
3. myeloma

Question 5

What are RF for TIA?

Answer 5

1. AF
2. Valvular disease
3. Carotid stenosis
4. Congestive heart failure
5. Hypertension
6. DM
7. Cigs
8. Alcohol use disorder
9. Advanced age

Question 6

What are signs of TIA specific to?

Answer 6

specific to arterial territory involved

Question 7

When may you get amaurosis fugax occur?

Answer 7

when retinal artery excluded

Question 8

What events are NOT typical for TIA?

Answer 8

global events (syncope dizziness) not typical for TIA

Question 9

What are signs and symptoms for TIA?

Answer 9

1. Multiple attacks indicated critical intracranial stenosis
2. Sudden onset few mins-24hr
3. Focal neurological deficit completely resolved within 24 hours of onset

Question 10

What are DDx for TIA?

Answer 10

1. Hypoglycaemia
2. Migraine aura
3. Focal epilepsy
4. Hyperventilation
5. Retinal bleeds
6. Stroke
7. MS
8. SOL

Question 11

What bloods are done for TIA?

Answer 11

1. FBC
2. ESR
3. U+Es
4. Glucose: to check hypoglycaemia
5. Lipids

Question 12

What would bloods show in TIA?

Answer 12

Usually all normal but can show if Atherosclerotic RF

Question 13

What other tests are done in TIA?

Answer 13

1. CXR
2. ECG
3. Carotid doppler ± angiography
4. CT
5. MRI
6. Echo

Question 14

What must you exclude for TIA?

Answer 14

exclude hypoglycaemia

Question 15

What is the management for suspected TIA?

Answer 15

1st line: antiplatelet therapy e.g. aspirin 300mg orally or clopidogrel 300mg orally
-Refer to specialist

Question 16

What is the management for confirmed YIA»

Answer 16

• 1st line: antiplatelet therapy e.g. clopidogrel 75mg or aspirin 75mg + high-intensity statin e.g. atorvastatin 20-80mg orally daily
• Consider anticoagulant for AF e.g. LMWH

Question 17

What should you have withtin 2 weeks of TIA?

Answer 17

Carotid endarterectomy withing 2wks

Question 18

What are possible complications of TIA?

Answer 18

1. Stoke

2. MI

Question 19

What should you not do after TIA?

Answer 19

driving prohibited for at least one month

Question 20

What is LT risk for TIA?

Answer 20

stroke or cardio events following TIA depend on underlying vascular RFLA ABCD score

Question 21

How likely is developing stroke after TIA?

Answer 21

• 8% have a stroke in hospital

- >10% develop stroke within 3 months

Question 22

When should you have a specilist review?

Answer 22

1. If presenting within 7 days of episode:
   Specialist review within 24 hours
2. If presenting after 7 days of episode:
   Specialist review within 7 days

Question 23

What is the secondary prevention for TIA?

Answer 23

1. Clopidogrel 75mg orally once daily
2. High intensity statin eg. atorvastatin orally once daily
3. BP control with antihypertensive if necessary

Question 24

What score is used to estimate stroke risk in TIA?

Answer 24

ABCD2

Question 25

What is part of ABCD2?

Answer 25

1. Age: >60 = 1
2. BP: >140/90 =1
3. Clinical presentation: unilateral leg weakness = 2, speech impairment = 1 and retinal = 0
4. Duration of symptoms: >60mins = 2 and 10-59 = 1
5. DM: Yes = 1

Question 26

What does score over 4 and 6 mean?

Answer 26

1. Score ≥ 4 → Referral to stroke specialist
2. Score ≥ 6 correlates with:
   - 8.1% risk of stroke within two days
   - 35.5% risk of stroke within one week