TIA Flashcards by Mohammed M Ahmed

What is a TIA

Temporary focal cerebral ischaemia which presents suddenly with brief neurological deficit

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How long do TIAs last

5-10 mins attack
<24 hours without infarction

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What are the risk factors for TIA

Age
HTN/smoking and diabetes
Hyperlipidaemia
AF
Clotting disorders
Combine OC pill

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What are the causes of TIA

Atherothromboembolism
-Carotid artery (hear a carotid bruit)

Cardioembolism
-AF
-Post MI
-Valve disease

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What are the Carotid presentations of TIA (90%)

Amourosis Fugax
Aphasia (can't communicate)
Hemiparesis (Cant move one side)
Hemisensory loss (Can't feel one side)
Hemianopic vision loss

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What are the Vertebrobasilar presentations of TIA (10%)

Vertigo
Choking and vomiting
Ataxia
Hemisensory loss
Hemianopic vision loss
Tetraparesis (4 limb weakness)

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What is Amourosis fugax

Unilateral sudden vision loss caused by Retinal artery occlusion

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How would you investigate a TIA

FAST (Public health scheme)
ABCD2
Brain Imaging
Carotid Imaging (Doppler US/Angiography)
ECG

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What blood tests would you do for a TIA

Glucose
FBC = Polycythaemia
ESR = Raised in vaculitis
INR = If on Warfarin

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What is the ABCD2 score used for after TIA

To check risk of Stroke
A-age >60
B-BP >140/90
C- Check symptoms 
D- Duration of symptoms
D- Diabetes

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How would you manage a TIA

300mg Aspirin
Prophylaxis Therapy
-Clopidogrel w/ Atorvastatin
Anticoagulation for AF
Carotid Endarterectomy

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When would you do Carotid endarterectomy

If stenosis greater than 70%

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What are the Focal neurological deficits of TIA

ACA = Contralateral leg numb and weak
MCA = Contralateral body weak and numb, forehead spared face droop and dysphagia
Amaourosis Fugax
PCA = Vision loss (Macular sparing contralateral hamonymous hemianopia)
Vertebral = Cerebellar syndrome, brainstem infarct and CN Lesions 3-12

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What is a sign of the TIA affecting ACA

Contralateral leg numbness and weak

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What is a sign of a TIA affecting the MCA

Contralateral body weakness and numb
Forehead sparing face droop
Dysphagia

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What is a sign of TIA affecting the PCA

Contralateral homnoymous hemianopia
(macular sparing)

-Macular sparing

What are the signs of TIA affecting the vertebral artery

Cerebellar syndrome (Positive romberg)
Brainstem infarct
CN 3-12 Lesions

What is cerebellar syndrome

Sensory and motor ataxia
Positive romberg

Dx with Positive Romberg test

What are the 2 scoring systems used in TIA

FAST
ABCD2

ABCD2

Acute management of TIA

Aspirin 300mg

Prophylaxis of TIA

Clopidogrel 75mg and atorvastatin 80mg

CN1 Lesion

Olfactory - unilateral anosmia

CN2 Lesion

Optic- visual loss/field defects

CN3 Lesion

Occulomotor - Ptosis (Loss of levateaur palpebrae function)

CN4 Lesion

Trochlear - Diplopia with no down and out movement

CN5 Lesion

Trigeminal - Facial anaesthesia and pain (episodic)

CN6 Lesion

Abducens - Diplopia with no lateral movement

CN7 Lesion

Facial - Hemifacial paralysis (LMN/UMN)/Bell's Palsy

CN8 Lesion

Vestibulocochlear - Deafness

CN9 Lesion

Glossopharyngeal - Loss of palatal elevation

Occlusion of what arteries can lead to amourosis fugax

Opthalmic and retinal arteries

What three things shhould be considered before antithrombolytic therapy with aspirin

1. Bleeding disorder and DOAC treatment 2. Patient already on low dose aspirin 3. Aspirin is contraindicated

Should Brain CT be done for TIA

It should be avoided unless clinical exam suggests alternative diagnosis to TIA

What is the recommended imaging used in TIA for ischaemia determination

MRI on same day of referral

Atheroembolisms can play a role in TIA formation; what imaging should be offered to determine source

Urgent carotid doppler (Carotid endaerterectomy)

Antiplatelet therapy follows aspirin use in management as 2nd line; what should a patient contraindicated with clopidogrel be offered

Dipyradimole

What is the aim of atorvastatin in TIA

Reduce LDL Cholesterol by more than 40%

When should carotid endarterectomy be considered

carotid stenosis >70%