TIA Flashcards
A TIA is a sudden onset focal neurological deficit which is (how long?) and with/without infarction
Under 24 hours without infarction
Typically how long is a TIA?
5-15 minutes
90% of the time, a TIA involves the ___ (blood supply)
anterior circulation via internal carotid artery
10% of the time, TIA involves the ____ (blood supply)
posterior circulation via the vertebral artery
What causes a TIA?
Carotid thrombo-emboli
Atherosclerosis narrow artery reducing the blood flow. A small piece of plaque or blood clot breaks loose and temporarily blocks a blood vessel in the brain.
Or an emboli from AF, or carotid arteries travels and lodges in brain vessel
What scoring system is used in management of AF?
CHA2DS2-VASc
Helps guide decisions regarding anticoagulation therapy
What are the components of CHA2DS2-VASc?
Congestive heart failure (1)
Hypertension (1)
A2 = Age 75+ (2”
Diabetes mellitus (1)
S2 = Stroke or TIA (2)
Vascular disease (1)
Age 65-74 (1)
Sc = sex category, if female (1)
The use of anticoagulation is generally recommended for individuals with a CHA2DS2 VASc score of _ or higher for men and _ or higher in females
2+ for men
3+ for women
What are risk factors for TIA?
Smoking
Diabetes T2
Hypertension
AF
Obesity / hypercholesterolemia
VSD (ventricle septal defect)
The risk factors for TIA are the same as the risk factors for ___
IHD (ischaemic heart disease)
If the anterior cerebral artery is blocked, what symptom will occur?
Weak and numb contralateral leg
If the middle cerebral artery is blocked, what symptoms will occur?
Weak numb contralateral side of body
Face drooping but forehead spared
Dysphasia
What does the term amaurosis fugax mean?
“transient darkening”, temporary loss of vision through one eye
Due to occlusion or decreased blood flow to retina through ophthalmic, retinal or ciliary artery.
Is a bad sign, often signals a stroke is impending
If the posterior cerebral artery is blocked, what symptom will occur?
Vision loss (contralateral homonymous hemianopia with macular sparing)
Due to loss of blood to occipital cortex
if the vertebral artery is blocked, what symptoms will occur?
Cerebellar syndrome (think DANISH):
Dysdiadochokinesis (unable to quickly flip hand)
Ataxia (co-ordination, balance, speech)
Nystagmus (involuntary rhythmic eye movements)
Intention tremor (tremor eg when reaching something)
Scanning dysarthria (speech broken into syllables)
Heel-shin test positivity (patient runs their heel down contralateral shin)
Also:
Vertigo
Headache
N+V
What is the Romberg test?
Can the patient stand upright for a minute with their eyes closed
Positive means not able to, sign of sensory and motor ataxia.
happens when vertebral artery is occluded.
In a TIA how long do symptoms normally resolve within?
A few minutes
How is a TIA managed immediately?
Aspirin 300mg daily
Referral for specialist assessment within 24 hours
Diffusion-weighted MRI scan is investigation of choice
How is a TIA managed long term?
Clopidogrel 75mg
Atorvastatin 80mg
Bp control (ACE-i and diuretics)
Patients with a TIA are investigated for c____ a_____ s____ and __
carotid artery stenosis
AF
What is initiated for AF after TIA?
Anticoagulation
What interventions are available for carotid artery stenosis following a TIA?
Carotid endarterectomy
Angioplasty and stenting
What is the ABCD2 score?
Evaluates risk for possible ischaemic stroke after TIA
Age
Blood pressure
Clinical features
Duration of symptoms
Diabetes
Along with aspirin, what medication is given to a TIA patient with AF?
LMWH
Along with aspirin, what medication is given to a TIA patient with heart thrombus?
Warfarin + DOAC (eg apixaban)
What medications may be given for blood pressure control following a TIA?
ACE-inhibitors (eg Ramipril)
Diuretics (eg chlorothiazide)
What is example of a loop diuretic? (unrelated to TIA)
Furesomide
(used for oedema in HF or kidney disease or liver scarring)
Give an example of a potassium-sparing diuretic (unrelated to TIA)
Spironolactone
