TIA Flashcards
What is a TIA
Temporary focal cerebral ischaemia which presents suddenly with brief neurological deficit
How long do TIAs last
5-10 mins attack
<24 hours without infarction
What are the risk factors for TIA
Age HTN/smoking and diabetes Hyperlipidaemia AF Clotting disorders Combine OC pill
What are the causes of TIA
Atherothromboembolism -Carotid artery (hear a carotid bruit) Cardioembolism -AF -Post MI -Valve disease
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
What are the Vertebrobasilar presentations of TIA (10%)
Vertigo Choking and vomiting Ataxia Hemisensory loss Hemianopic vision loss Tetraparesis (4 limb weakness)
What is Amourosis fugax
Unilateral sudden vision loss caused by Retinal artery occlusion
How would you investigate a TIA
FAST (Public health scheme) ABCD2 Brain Imaging Carotid Imaging (Doppler US/Angiography) ECG
What blood tests would you do for a TIA
Glucose
FBC = Polycythaemia
ESR = Raised in vaculitis
INR = If on Warfarin
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
How would you manage a TIA
300mg Aspirin Prophylaxis Therapy -Clopidogrel w/ Atorvastatin Anticoagulation for AF Carotid Endarterectomy
When would you do Carotid endarterectomy
If stenosis greater than 70%
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
What is a sign of the TIA affecting ACA
Contralateral leg numbness and weak
What is a sign of a TIA affecting the MCA
Contralateral body weakness and numb
Forehead sparing face droop
Dysphagia
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
- Bleeding disorder and DOAC treatment
- Patient already on low dose aspirin
- 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%
