TIA

Question 1

what is the definition of a TIA?

Answer 1

Neurological deficit lasting less than 24 hours attributable to cerebral or retinal ischaemia

Question 2

Can TIA cause lastin brain damage?

Answer 2

Yes

Question 3

What are the 3 reasons for distinguishing between TIA and stroke when both can cause lasting brain damage and the causes are the same?

Answer 3

1) Distinction of research purposes
2) TIA indicates ischaemic pathology - sympoms can only resolve within 24 hours if vascular not haemorrhage
3) TIAs represent a window of opportunity to treat (20% of strokes will be preceeded by TIA)

Question 4

What is the incidence of TIAs - the average GP will see how many cases per year?

Answer 4

50/100,00 population

Avergae GP will see 5 cases per year

Question 5

Would a TIA give you positive or negative symptoms?

Answer 5

Negative symptoms - its the absence of function

Question 6

Give 2 examples of something which could cause positive neurological symptoms?

Answer 6

A seizure - eg. involuntary body movements

The aura preceding a migraine - eg. flashing lights

Question 7

TIA can mimic what 5 conditions?

Answer 7

1) Seizures
2) Syncope
3) Hypoglycaemia
4) Migraine
5) Acute confusional states

Question 8

What would be the 4 common symptoms of an anterior circulation occlusion causing TIA?

Answer 8

1) Amarausis fugax - if clot affects the ophthalmic artery coming off the ICA
2) Dysphasia - if gets left hemisphere
3) Apraxia
4) Inattention - if gets right hemisphere

Question 9

What is apraxia?

Answer 9

Inability to perform purposive movements

Question 10

What is amarausis fugax?

Answer 10

Transient monocular vision loss

Question 11

What is ataxia?

Answer 11

Loss of balance

Question 12

What are the 4 main signs/symptoms of a posterior circulation occlusion?

Answer 12

1) Ataxia
2) Diplopia
3) Vertigo
4) Bilateral symptoms

Question 13

What 4 signs and symptoms found on assessment could be attributable to an anterior or posterior circulation occlusion?

Answer 13

1) Visual field disturbance (eg. hemianopia)
2) Hemiparesis
3) Hemisensory loss
4) Dysarthria (slurred speech)

Question 14

What is the name of score used to assess stroke risk following TIA?

Answer 14

ABCD2 score

Question 15

ABCD2 score takes into account and attributes points to which 5 factors?

Answer 15

1) Age
2) BP
3) Clinical features (unilateral weakness or speech disturbance)
4) Duration of symptoms
5) Diabetes

Question 16

What would be a low risk, a moderate and a high risk ABCD2 score for TIA?

Answer 16

Low = 5

Question 17

What kind of TIAs are high risk regardless of ABCD2 score?

Answer 17

Recurrent crescendo TIAs

Question 18

A TIA with a high risk ABCD2 score is assoicated with what percentage risk fo stroke within 2,7 and 90 days?

Answer 18

2 - 8.1%
7- 11.7%
90 - 17.8%

Question 19

Why should a blood glucose test be included with history and examination in investigations of TIAs?

Answer 19

Because hypoglycaemia is a mimic of TIA

Question 20

What 4 drugs would be useful primary prevention for cerebral events?

Answer 20

1) Statins
2) Aspirin
3) Anti-hypertensives
4) Folic acid

Question 21

What 2 treatments for TIA reduce stroke risk?

Answer 21

1) Carotid endarterectomy

2) Immediate medical management with aspirin +/- clopidogrel, antihypertensives, statins

Question 22

Is there any intervention for an occluded carotid artery?

Answer 22

No - it is technically impossible, but there is a lower risk fo further events if good collaterals