TIA

Question 0

What two type of atheroma can cause a TIA

Answer 0

Intracranial and extra cranial

Question 1

Define transient ischaemic attack 2002

Answer 1

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)

Question 2

Name 4 common causes of TIA

Answer 2

Intracranial and extra cranial atheromas
Atherothrombosis
Embolism
Hypo perfusion

Question 3

What factors are involved in cardioembolic TIA

Answer 3

Atrial fibrillation
Mural thrombus
Septic embolis 
Malignancy atrial myxoma 
Thrombosis on a mechanical heart valve 
Calcification embolis from aortic valve 
Paradoxical embolus /PFO

Question 4

What does rothwell score indicate

Answer 4

7 day risk of stroke

Question 5

Describe atrial fibrillation

Answer 5

Tiny irregular fibrillation waves between heartbeats, the rhythm is irregular and erratic

Question 6

Carotid ultrasound is useful to…

Answer 6

Examine blood flow to brain from carotid artery in high risk TIA/stroke patients

Question 7

Who is carotid endarterectomy beneficial to?

Answer 7

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

Question 8

What four cardiology investigations are useful in TIA

Answer 8

Echocardiography
Trans cranial Doppler
Holter monitor
Heart brain MDT

Question 9

Describe the process of a thrombosis

Answer 9

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

Question 10

What are the 5 treatments for TIA

Answer 10

Anti platelets 
Statins 
Anticoagulants 
Blood pressure drugs 
Lifestyle advice

Question 11

Statins decrease and reduce

Answer 11

Decrease CRP
reduce cytokines
Reduce chemokines
Reduce adhesion molecules

Question 12

Cholesterol lowering statin drugs work by inhibiting

Answer 12

HMG-CoA. Reducatase

Question 13

What two mechanisms do anticoagulants work by

Answer 13

VitaminK antagonists

Direct thrombin inhibitors

Question 14

Outline RCP guidelines for secondary prevention of stroke and TIA (2004)

Answer 14

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

Question 15

According to RCP guidelines, what should all AF patients be treated with unless contraindicated

Answer 15

Anticoagulants (AFFIRM 2002)

Question 16

According to RCP guidelines when should anticoagulants be administered after TIA

Answer 16

Not until CT scan has excluded haemorrhage and usually not until 14 days post event

Question 17

Over what blood cholesterol level should statins be given according to RCP guidelines

Answer 17

3.5 (HPS 2004)

Question 18

Any patient with carotid tertiary stoke without severe disability should be considered for …….

Answer 18

Carotid intervention

Question 19

What are the main ways of treating TIA

Answer 19

Unblock narrowed arteries 
Make blood less sticky - anti platelets 
Prevent thrombosis with anticoagulants 
Reduce atheroma with statins 
Reduce hypertensive disease with blood pressure drugs

Question 20

Describe so evidence that preventative measures are making a difference

Answer 20

Change in stroke incidence in Oxfordshire from 1981 to 2004 fell by 49% in association with increased use of preventative treatments lancet 2004