TIA Flashcards
What is a TIA?
Temporary, focal cerebral ischaemia that results in reversible neurological deficits without acute infarction that resolves completely within 24 hours.
Due to a transient decrease in blood flow.
What demographics do TIA’s happen in most commonly?
M>F; Incidence increases with age.
What are the risk factors for a TIA?
Atrial Fibrillation, Valvular disease, Carotid stenosis, Congestive heart failure, Hypertension, Diabetes Mellitus, Smoking.
What can cause a TIA?
Thrombosis of an intracranial artery due to a cardioembolic event; Small vessel occlusion/narrowing due to hypertension, diabetes, smoking; Hypoperfusion.
What are the main clinical features of a TIA?
Sudden onset & brief duration of symptoms; Unilateral weakness or paralysis; Dysphasia (LEFT LESION); Ataxia, VERTIGO - POSTERIOR TIA; Homonymous hemianopia; Diplopia.
What bedside investigations do we do for TIA?
Neurological examinations, Basic observations, ECG to evaluate for AF and rule out myocardial ischaemia.
What blood tests can we do for TIA and why?
Blood glucose to exclude hypoglycaemia; PT, International Normalised Ratio, APTT to exclude coagulopathy.
What imaging do we order for all patients suspected of TIA?
Urgent carotid doppler to assess any stenosis or plaques in the carotids.
What other scans can we do in suspected TIA?
MRI brain with diffusion-weighted imaging - Tell us the area of interest - preferred to CT ; CT head if patient has bleeding disorder or is on anticoagulation.
What score do we calculate in TIA patients and why?
ABCD2 score to estimate stroke risk in TIA patients. 4 or more indicates severe stroke risk from TIA.
What is the gold standard treatment for TIA?
Antiplatelet Therapy → Aspirin 300mg (or Clopidogrel) immediately; Aspirin for 2 weeks, then switch to lifelong clopidogrel (75mg once daily for life).
What if patients are on anticoagulants and they have a TIA?
Do CT head first to rule out haemorrhage before the antiplatelet therapy.
What do we do if patients present with symptoms within a 7 day window of the TIA episode?
Specialist review within 24 hours as the first 7 days after a stroke are the most high risk.
What do we do if patients present with symptoms after 7 days of TIA episode?
Specialist review within 7 days - not as urgent.
What medication can be used for secondary long-term prevention of TIA?
Atorvastatin 80mg + antihypertensives.
What if the patient has carotid artery stenosis causing a TIA?
If carotid artery stenosis is >70%, then Carotid endarterectomy is done to restore normal blood flow.
In AF patients with a TIA, what anticoagulant do we give?
DOAC or Low Molecular Weight Heparin.
What can patients not do for 1 month at least after a TIA?
Drive.
What are the complications of a TIA?
Stroke, Myocardial Infarction.
What is the prognosis of TIA?
By definition, a patient with a TIA has no residual symptoms from the primary event, but has increased risk of future ischaemic stroke.
