TIA Flashcards
What two type of atheroma can cause a TIA
Intracranial and extra cranial
Define transient ischaemic attack 2002
A brief episode of neurological dysfunction caused by a focal brain or retinal ischemia, with clinical symptoms lasting less than an hour and without evidence for acute infection (Albers et al 2002)
Name 4 common causes of TIA
Intracranial and extra cranial atheromas
Atherothrombosis
Embolism
Hypo perfusion
What factors are involved in cardioembolic TIA
Atrial fibrillation Mural thrombus Septic embolis Malignancy atrial myxoma Thrombosis on a mechanical heart valve Calcification embolis from aortic valve Paradoxical embolus /PFO
What does rothwell score indicate
7 day risk of stroke
Describe atrial fibrillation
Tiny irregular fibrillation waves between heartbeats, the rhythm is irregular and erratic
Carotid ultrasound is useful to…
Examine blood flow to brain from carotid artery in high risk TIA/stroke patients
Who is carotid endarterectomy beneficial to?
Symptomatic patients with recent (within two to four weeks) hemispheric, non disabling, carotid artery ischaemic events and ipsilateral 70 to 99% carotid artery stenosis
May be beneficial to patients with retinal transient ischaemia
What four cardiology investigations are useful in TIA
Echocardiography
Trans cranial Doppler
Holter monitor
Heart brain MDT
Describe the process of a thrombosis
Exposed endothelial surface collagen
Vasoactive substances reduced, endothelin
Platelets stick to damaged vessel wall
Release Von willebrand factor strings of VWF that promote coagulation factors in blood to form fibrin
More platelets from a plug with fibrin strand and red thrombus formed
What are the 5 treatments for TIA
Anti platelets Statins Anticoagulants Blood pressure drugs Lifestyle advice
Statins decrease and reduce
Decrease CRP
reduce cytokines
Reduce chemokines
Reduce adhesion molecules
Cholesterol lowering statin drugs work by inhibiting
HMG-CoA. Reducatase
What two mechanisms do anticoagulants work by
VitaminK antagonists
Direct thrombin inhibitors
Outline RCP guidelines for secondary prevention of stroke and TIA (2004)
All patients should be given advice in lifestyle
High BP persisting over 2/52 should be treated with thiazides diuretic and or ACE inhibitor unless contraindicated
Anti platelet agent aspirin and dipyridamole/ clopidogrel if aspirin intolerant
According to RCP guidelines, what should all AF patients be treated with unless contraindicated
Anticoagulants (AFFIRM 2002)
According to RCP guidelines when should anticoagulants be administered after TIA
Not until CT scan has excluded haemorrhage and usually not until 14 days post event
Over what blood cholesterol level should statins be given according to RCP guidelines
3.5 (HPS 2004)
Any patient with carotid tertiary stoke without severe disability should be considered for …….
Carotid intervention
What are the main ways of treating TIA
Unblock narrowed arteries Make blood less sticky - anti platelets Prevent thrombosis with anticoagulants Reduce atheroma with statins Reduce hypertensive disease with blood pressure drugs
Describe so evidence that preventative measures are making a difference
Change in stroke incidence in Oxfordshire from 1981 to 2004 fell by 49% in association with increased use of preventative treatments lancet 2004
