TIA Flashcards
What offer to someone with suspected TIA?
Offer aspirin 300mg immediately unless contraindicated
What is first line investigation for TIA?
CT to exclude haemorrhage
What is a TIA?
Transient - less than 24 hours - neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without evidence of acute infarction. Most resolve within one hour
Intracerebral bleed vs subarrach causes
IC bleeds occur due to diseases affecting small cerebral vessels eg HPTN
SAH - aneurysms, AV malformations, dissections, anticoags etc
Conditions risk factors for stroke
Migraine
Hyperlipidaemia.
Diabetes mellitus.
Sickle cell disease.
Haemophilia.
Antiphospholipid syndrome and other hypercoagulable disorders.
Chronic kidney disease.
Ehlers-Danlos syndrome.
Marfan syndrome.
Pseudoxanthoma elasticum.
Polycystic kidney disease.
Neurofibromatosis type I.
Obstructive sleep apnoea
Vascular malformations
Peripheral vascular disease
Establisjed cardiovascular disease
Early complications of stroke
HAEMORRHAGIC TRANSOFRMATION
Cerebral oedema
Delirium
Seizures
Venous throboembolism -> PE
Cardiac complications - MI, HF, AF, arrhythmias
Infection
Mobility problems after stroke
Hemiparesis or plegia
Atacia
Falls
Spasticity and contractures
Loss/altered sensation
Why pain after stroke long term?
MSK - abnormal positioning etc
Neuropathic
Cognitive problems after stroke
Dyspraxia
Impaired attention and concentration
Impaired executive function
Spatial awarenedd eg left sided neglect, hemianopia
Visual problems after stroke
Altered acuity, hemianopia, diplopia, nysstagmus, blurred
Visual problems after stroke
Altered acuity, hemianopia, diplopia, nysstagmus, blurred
Communication problems after
Causes of TIA
Thrombus formation eg AF
Atherosclerosis
Shock
Vasculitis
PresenationTIA
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss
FAST tool
Face
Arm
Speec
Time - act fast 999
ROSIER tool when is stroke likely
If score above 0
Secondary prevention of stroke medication(long term managemtent)
Clopidogrel 75mg oncec daily
Atorvastatin 70mg
Carotid endarectomy or stent if CAD
Treat modifiable risk factors
Causes of TIA
embolic, thrombotic, haemorrhagic
Carotid bifurcation
Long term prevention of TIA
HPTN, DM, obesity, smoking - decerase risk factors/treat
Investigations TIA
BLoods
ECG/ambulatory ECG
CT brain
MRI brain
Carotid imaging eg doppler and duplex, CTPA
Transoesophageal ECHO
What bloods do in TIA
FBC, ESR/CRP, U+Es, LFTs, TFTs, glucose cholesterol, clotting factors and antiphospholipid antibodies
What are CT brain and MRI used for?m
Rule out haemorrhage
MRI - region of ischaemia
Why do carotid imaging in TIA
Check for atheroma and stenosis
ECHO in TIA for what
Rule out transmural thrombus, valvular HD
How long cant drive after a TIA vs multiple
1 month
Multiple over short period - 3 months + notify DVLA
What are the features of carotid territory symptoms?
Amourosis fugax
Aphasia
Hemiparesis
Hemisensory loss
Hemianopic visual loss
Features of vertobrobasilar territory symptoms
Diplopi a
Vertigo
Vommitting
Choking and dysarthria
Ataxia
Hemisensory loss
Hemianopic or bilateral visual loss
Tetraparesis
LOC
Features of vertobrobasilar territory symptoms
Diplopi a
Vertigo
Vommitting
Choking and dysarthria
Ataxia
Hemisensory loss
Hemianopic or bilateral visual loss
Tetraparesis
LOC
Differentials for TIA
Stroke
Hypoglycaemia
Migraine with aura
Focal epilepsy
Intracranial lesion eg tumour or haemorrhage
Hyperventialtion
Retinal or vitreous haemorrhage
Labyrinth disorder
Maliganant HPTN
Score for deciding TIA managment
ABCD2 score
ABCD2 score
Age over 60
BP over 140/90
Clinical featires - unilateral weakness, speech disturbance
Duration symptoms - over 60 mins = 2, 10-59 imns = 1
Diabetes w
What is low risk and high risk on ABCD2
1-3 = low
6-7 = high
Absolute contraindications for thrombolysis in stroke
Prev intracrnaial haemorrhage
Seizure at onset of stroke
Intracranial neoplasm
Sus SAH
Stroke/traumatic head injury prev 3 months
LP in last week
GI haemorrhage last 3 weeks
Active bleed
Pregnancy
Oesophageal varices
Uncontrolled HPTN >200/120
Relative contraindications for thrombolysis stoke
Concurrent anticoagulation - INR >1.7
Haemorrhegic diathesis
Active diabetic haemorrhagic retinopathy
Sus intracardiac thrommbus
Major surgery or trauma in last 2 weeks
Relative contraindications for thrombolysis stoke
Concurrent anticoagulation - INR >1.7
Haemorrhegic diathesis
Active diabetic haemorrhagic retinopathy
Sus intracardiac thrommbus
Major surgery or trauma in last 2 weeks
