TIA

Question 1

def

Answer 1

sudden onset of focal neurological deficit with symptoms lasting <24hrs

Question 2

aetiology

Answer 2

lack of blood flow (ischaemia) to the brain due to occlusion of cerebral circulation
1 atherothromboembolism
-an atheromatous plaque from atheroscleotic carotids travels as am embolus to occlude blood flow (most common cause)
2 cardioembolism
-commonly AF
3 hyperviscosity
-polycythaemia
-sickle cell anaemia

Question 3

epi

Answer 3

increases with age

more common in those with risk factors (carotid stenosis, smoking + alcohol use, DM, HTN, high cholesterol, AF)

Question 4

history

Answer 4

patient reports sudden onset focal neurological deficit
-unilateral weakness or loss of sensation
-hemianopia
-dysarthria or dysphasia
symptoms last <24hrs

Question 5

what is amaurosis fugax

Answer 5

one eye’s vision is lost “like a curtain descending over my field of view)
caused by emboli in the retinal artery

Question 6

examination

Answer 6

signs of cause
-carotid bruit
-heart murmur from valvular disease
-AF
focal neurological deficit
-unilateral weakness or loss of sensation
-hemianopia
-dysarthria or dysphasia

Question 7

investigations

Answer 7

1 bloods
-FBC (for polycythaemia, sickle cell anaemia)
-glucose (low glucose could mimic a TIA)
2 carotid doppler
3 ECG
-for AF
4 CT/MRI
-can localise infarct
-can distinguish between stroke + TIA

Question 8

management

Answer 8

there is an increased risk of stroke following a TIA if it is not treated
1 control CVS risk factors
2 antiplatelets
-clopidogrel + aspirin
3 warfarin
-indicated with cardioembolic TIA (AF, mitral stenosis)
4 carotid endarterectomy if >70% stenosis

Question 9

complications

Answer 9

stroke

MI

Question 10

prognosis

Answer 10

combined risk of stroke and MI post TIA is 10%

this risk increases with carotid stenosis >70%

Question 11

what is the ABCD2 score

Answer 11

score which predicts risk of stroke following a TIA

Question 12

what are features of the ABCD2 score

Answer 12

Age >60yrs (1)
BP >140/90 (1)
Clinical features
-unilateral weakness (2)
-speech disturbance without weakness (1)
Duration of symptoms
->1h (2)
-10-59minutes (1)
Diabetes (1)