TIA

Question 1

Describe a TIA?

Answer 1

• Ischaemic neurological event with symptoms lasting <24 hrs
  
  • Often last much shorter
• Wo/ intervention, 1 in 12 patients will have a stroke within a week

Question 2

Signs of a TIA?

Answer 2

• Specific to arterial territory involved
• Amaurosis fugax can occur when retinal artery is occluded
• Global events are not typical of TIAs

Question 3

What do multiple highly sterotyped attacks (crescendo TIAs) indicate?

Answer 3

• Ciritcal intracranial stenosis
  
  • commonly in the superior division of the middle cerebral artery

Question 4

Causes of TIAs?

Answer 4

• Atherothromboembolism is the chief cause
• Cardioembolism
  
  • mural thrombus, post MI or in AF
• Hyperviscosity
  
  • polycythaemia, sickle cell, myeloma
• Vasculitis is a non-embolic cause of TIA symptoms

Question 5

Differentials for TIA?

Answer 5

• Hypoglycaemia
• Migraine aura
• Focal epilepsy
• Retinal bleeds

Question 6

Tests for a TIA?

Answer 6

• FBC, ESR, U&Es, glucose, lipids
• CXR, ECG, echo
• Carotid doppler +/- angiography
• Diffusion-weighted MRI

Question 7

Treatment for TIA?

Answer 7

• Control CV risk factors
  
  • BP, hyperlipidaemia, smoking cessation services
• Antiplatelet drugs
  
  • Aspirin for 2 weeks, then clopidogrel
  • If clopidogrel contraindicate: aspirin combined with slow release dipyridamole
• Carotid endarterectomy

Question 8

Describe the considerations for driving when someone has a TIA?

Answer 8

Prohibited for 1 month

Question 9

When should a TIA lead to an emergency referral?

Answer 9

• ABCD² score
  
  • Stratifies patients at higher risk of having a stroke soon after a TIA
  • Score of 4 or more indicates high risk
  • Score of 6 or more strongly indicates stroke within 2 days