TIA

Question 1

What causes a TIA?

Answer 1

A transient obstruction of blood flow to the brain, spinal cord or retina

Question 2

How long do the symptoms and signs of a TIA usually last?

Answer 2

Usually last for an hour

Question 3

Will there be any evidence of acute infarction after a TIA?

Answer 3

No

Question 4

The symptoms and signs of a TIA must have completely resolved within how long?

Answer 4

24 hours

Question 5

The occurrence of a TIA suggests what?

Answer 5

Systemic atherosclerotic vascular disease and a high risk of stroke

Question 6

What are the commonest causes of TIA?

Answer 6

Atheroembolism and cardioembolism

Question 7

What are some risk factors for developing TIA?

Answer 7

Prior TIA/stroke, hypertension, AF, diabetes, history of IHD, smoking

Question 8

Clinical features of a TIA depend on what?

Answer 8

The vascular territory which is affected

Question 9

What are some clinical features (general) that a TIA could cause?

Answer 9

Cortical symptoms, speech abnormalities, visual field defects, cranial nerve involvement, memory disturbance

Question 10

Amarousis fugax is caused by a TIA affecting which vessel?

Answer 10

Retinal artery

Question 11

What happens in amarousis fugax?

Answer 11

A rapid, painless loss of vision ‘like a curtain coming down’

Question 12

What is the main aim of investigation for TIA?

Answer 12

To identify the cause and determine the degree of risk

Question 13

When a person presents with a TIA you should do a thorough clinical examination particularly including what things?

Answer 13

Listening for cardiac murmurs and arrhythmias and auscultating for carotid bruit

Question 14

Which scoring system is used to guide the urgency of investigations and implementation of secondary measures for TIA?

Answer 14

ABCD2

Question 15

What are the 5 features of the ABCD2 scoring system?

Answer 15

Age, blood pressure, clinical features, duration, diabetes

Question 16

What are the 3 features of the ABCD2 scoring system which would always score a patient 1 point if present?

Answer 16

Age 60+, BP 140/90+, diabetes

Question 17

How many points could patients score on the ABCD2 system for their clinical features?

Answer 17

If weakness = 2 points / if speech defect without weakness = 1 point

Question 18

How many points could patients score on the ABCD2 system for the duration of their symptoms?

Answer 18

60+ minutes = 2 points / 10-59 minutes = 1 point

Question 19

An ABCD2 score of 4 or more warrants what management?

Answer 19

Seen by a stroke specialist in 24 hours

Question 20

An ABCD2 score of < 4 warrants what management?

Answer 20

Assessed and treated within 7 days

Question 21

What are the 5 main investigations for TIA?

Answer 21

MRI brain, carotid doppler, ECG, ECHO, bloods

Question 22

What blood tests are done for TIA and why?

Answer 22

FBC for blood disorders, renal function for renal failure, glucose for diabetes and CRP for vasculitis

Question 23

What is the role of management of a TIA?

Answer 23

To reduce the risk of a stroke

Question 24

What are some lifestyle measures that should be implicated following a TIA?

Answer 24

Smoking cessation, weight loss, exercise, decrease alcohol

Question 25

What 3 things need to be well controlled following a TIA?

Answer 25

Hypertension, diabetes and cholesterol

Question 26

What medical therapy is given following a TIA?

Answer 26

Anti-platelet

Question 27

How is anti-platelet therapy given following a TIA?

Answer 27

Aspirin 300mg for 2 weeks, clopidogrel 75mg for life (or warfarin if cardioembolic)

Question 28

What are some surgical management options which can be used for cardioembolic TIA?

Answer 28

Cardiac ablation for AF, valve repair/replacement for valvular disease, cardiac endarterectomy to remove plaques at the carotid bifurcation