TIA

Question 1

2020 stem: Man woke up with left-sided weakness, resolved after 30 mins. Has a bunch of risk factors, including 20 pack year smoking history, alcohol 2SD/day, fasting BSL 7.9, HTN, dyslipidaemia, AF. On a statin and ACEI. Vitals given - afebrile, BP 160/110.

Impression/DDx/Goals

Answer 1

Impression:
Most likely a presentation of transient ischaemic attack (TIA)

Important differentials to consider;

• Stroke
• Space-occupying lesion
• Stroke mimics (migraine + aura, seizure + todds paresis, hypoglycaemia)
• Syncopal episode (and variety of cardiogenic causes)

Goals of management:

• Rule out red flags and differential diagnoses
• Manage cardiovascular risk factors for ongoing stroke prevention

Question 2

Stroke/TIA - Risk factors

Answer 2

Non-modifiable:

• older age
• male gender
• family history
• previous stroke
• specific pathology: AF, carotid stenosis,

Modifiable:

• smoking
• alcohol
• sedentary lifestyle
• obesity
• hypercholesterolaemia
• diabetes

Question 3

Stroke/TIA - History

Answer 3

History:
- Sx: distinguish TIA/other. weakness, dysphagia, facial drooping (FAST)
F - facial weakness
A - arm weakness
S - speech 
T - time (time since sx onset)
- RF: Modifiable and non-modifiable factors of stroke
- PMHx, Surg Hx
- SNAP

Question 4

Stroke/TIA - Examination

Answer 4

Exam:

• ABCDE approach initially
• vital signs: LOC, reduced GCS
• neurological exam: signs of focal neurology
• cardiovascular exam: AF, murmurs, carotid stenosis

Question 5

Stroke/TIA - Investigations

Answer 5

Investigations:

• Bedside: vitals, ECG,
• Bloods: FBC, coags, UEC, LFT, lipid panel
• Imaging: refer to hospital for CTB non con (+/- CT angio/CT perfusion)

Question 6

Stroke/TIA - Management (GP)

Answer 6

Management:
If TIA
- Referral to hospital for stroke work-up/ stroke clinic
- having had TIA, is at a high risk of having.a stoke

Otherwise;
Non-pharm
- lifestyle modifications (diet, exercise, smoking cessation)

Pharm

• SABA (statin, aspirin, beta-blocker, ACEi)
• optimise their medical management/ start them on it

Safety-net

• to present to ED if there is any return of symptoms immediately
• Regular follow-up for ongoing management of cardiovascular disease risk factors