TIA

Question 1

A TIA is a sudden onset focal neurological deficit which is (how long?) and with/without infarction

Answer 1

Under 24 hours without infarction

Question 2

Typically how long is a TIA?

Answer 2

5-15 minutes

Question 3

90% of the time, a TIA involves the ___ (blood supply)

Answer 3

anterior circulation via internal carotid artery

Question 4

10% of the time, TIA involves the ____ (blood supply)

Answer 4

posterior circulation via the vertebral artery

Question 5

What causes a TIA?

Answer 5

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

Question 6

What scoring system is used in management of AF?

Answer 6

CHA2DS2-VASc

Helps guide decisions regarding anticoagulation therapy

Question 7

What are the components of CHA2DS2-VASc?

Answer 7

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)

Question 8

The use of anticoagulation is generally recommended for individuals with a CHA2DS2 VASc score of _ or higher for men and _ or higher in females

Answer 8

2+ for men
3+ for women

Question 9

What are risk factors for TIA?

Answer 9

Smoking
Diabetes T2
Hypertension
AF
Obesity / hypercholesterolemia
VSD (ventricle septal defect)

Question 10

The risk factors for TIA are the same as the risk factors for ___

Answer 10

IHD (ischaemic heart disease)

Question 11

If the anterior cerebral artery is blocked, what symptom will occur?

Answer 11

Weak and numb contralateral leg

Question 12

If the middle cerebral artery is blocked, what symptoms will occur?

Answer 12

Weak numb contralateral side of body
Face drooping but forehead spared
Dysphasia

Question 13

What does the term amaurosis fugax mean?

Answer 13

“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

Question 14

If the posterior cerebral artery is blocked, what symptom will occur?

Answer 14

Vision loss (contralateral homonymous hemianopia with macular sparing)

Due to loss of blood to occipital cortex

Question 15

if the vertebral artery is blocked, what symptoms will occur?

Answer 15

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

Question 16

What is the Romberg test?

Answer 16

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.

Question 17

In a TIA how long do symptoms normally resolve within?

Answer 17

A few minutes

Question 18

How is a TIA managed immediately?

Answer 18

Aspirin 300mg daily
Referral for specialist assessment within 24 hours
Diffusion-weighted MRI scan is investigation of choice

Question 19

How is a TIA managed long term?

Answer 19

Clopidogrel 75mg
Atorvastatin 80mg

Bp control (ACE-i and diuretics)

Question 20

Patients with a TIA are investigated for c____ a_____ s____ and __

Answer 20

carotid artery stenosis
AF

Question 21

What is initiated for AF after TIA?

Answer 21

Anticoagulation

Question 22

What interventions are available for carotid artery stenosis following a TIA?

Answer 22

Carotid endarterectomy
Angioplasty and stenting

Question 23

What is the ABCD2 score?

Answer 23

Evaluates risk for possible ischaemic stroke after TIA

Age
Blood pressure
Clinical features
Duration of symptoms
Diabetes

Question 24

Along with aspirin, what medication is given to a TIA patient with AF?

Answer 24

LMWH

Question 25

Along with aspirin, what medication is given to a TIA patient with heart thrombus?

Answer 25

Warfarin + DOAC (eg apixaban)

Question 26

What medications may be given for blood pressure control following a TIA?

Answer 26

ACE-inhibitors (eg Ramipril)
Diuretics (eg chlorothiazide)

Question 27

What is example of a loop diuretic? (unrelated to TIA)

Answer 27

Furesomide
(used for oedema in HF or kidney disease or liver scarring)

Question 28

Give an example of a potassium-sparing diuretic (unrelated to TIA)

Answer 28

Spironolactone