TIA Flashcards
What are the 3 group of causes of a TIA?
- Atherothromboembolism
- Cardioembolism
- Hyperviscosity
- Vasculitis can cause TIA symptoms
Why might you have atherothromboembolism?
from carotid (listen for bruits)
What are cardioembolism causes of TIA?
- post MI
- AF
- valve disease
What are hyperviscosity cause of TIA?
- polycythaemia
- sickle cell anaemia
- myeloma
What are RF for TIA?
- AF
- Valvular disease
- Carotid stenosis
- Congestive heart failure
- Hypertension
- DM
- Cigs
- Alcohol use disorder
- Advanced age
What are signs of TIA specific to?
specific to arterial territory involved
When may you get amaurosis fugax occur?
when retinal artery excluded
What events are NOT typical for TIA?
global events (syncope dizziness) not typical for TIA
What are signs and symptoms for TIA?
- Multiple attacks indicated critical intracranial stenosis
- Sudden onset few mins-24hr
- Focal neurological deficit completely resolved within 24 hours of onset
What are DDx for TIA?
- Hypoglycaemia
- Migraine aura
- Focal epilepsy
- Hyperventilation
- Retinal bleeds
- Stroke
- MS
- SOL
What bloods are done for TIA?
- FBC
- ESR
- U+Es
- Glucose: to check hypoglycaemia
- Lipids
What would bloods show in TIA?
Usually all normal but can show if Atherosclerotic RF
What other tests are done in TIA?
- CXR
- ECG
- Carotid doppler ± angiography
- CT
- MRI
- Echo
What must you exclude for TIA?
exclude hypoglycaemia
What is the management for suspected TIA?
1st line: antiplatelet therapy e.g. aspirin 300mg orally or clopidogrel 300mg orally
-Refer to specialist
What is the management for confirmed YIA»
- 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
What should you have withtin 2 weeks of TIA?
Carotid endarterectomy withing 2wks
What are possible complications of TIA?
- Stoke
2. MI
What should you not do after TIA?
driving prohibited for at least one month
What is LT risk for TIA?
stroke or cardio events following TIA depend on underlying vascular RFLA ABCD score
How likely is developing stroke after TIA?
- 8% have a stroke in hospital
- >10% develop stroke within 3 months
When should you have a specilist review?
- If presenting within 7 days of episode:
Specialist review within 24 hours - If presenting after 7 days of episode:
Specialist review within 7 days
What is the secondary prevention for TIA?
- Clopidogrel 75mg orally once daily
- High intensity statin eg. atorvastatin orally once daily
- BP control with antihypertensive if necessary
What score is used to estimate stroke risk in TIA?
ABCD2
What is part of ABCD2?
- Age: >60 = 1
- BP: >140/90 =1
- Clinical presentation: unilateral leg weakness = 2, speech impairment = 1 and retinal = 0
- Duration of symptoms: >60mins = 2 and 10-59 = 1
- DM: Yes = 1
What does score over 4 and 6 mean?
- Score ≥ 4 → Referral to stroke specialist
- Score ≥ 6 correlates with:
- 8.1% risk of stroke within two days
- 35.5% risk of stroke within one week
