TIA

Question 1

Define:

Answer 1

Rapidly developing focal disturbance of brain function of presumed vascular origin resolving in 24 hrs

Question 2

Aetiology:

Answer 2

Usually due to emboli but can be due to thombosis.

Most common cause is carotid atherosclerosis

Carotid cardioembolism can cause TIA if:

• mural thrombus most MI and AF
• Mitral valve disease
• Atrial myxoma
• Prosthetic valve

Clots on the RHS can cause a stroke if there is a septal defect.

Rare - vasculitis and hyerviscosity

Question 3

Risk factors:

Answer 3

Smoking 
Alcohol
DM 
COCP
Peripheral arterial disease
Polycycathemia 
Hyperlipidemia
HTN 
Heart disease 
Clotting disorders

Question 4

Epidemiology:

Answer 4

15% of those who have had a stroke would have had a TIA

More common in increasing age and in men

0.4/1000 per year

Question 5

Symptoms

Answer 5

Lasts 10-15 mins usually but can last up to 24 hrs.

Have syncope and dizziness often

Question 6

Symptoms of carotid territory TIA:

Answer 6

• Unilateral
• Most often affect the MOTOR AREA: weakness an arm, leg or one side of the face
• Dysarthria
• Broca’s dysphasia (if Broca’s area is involved)
• Amaurosis fugax (painless fleeting loss of vision caused by retinal ischaemia)

Question 7

Symptoms of vertebrobasilar:

Answer 7

• Homonymous hemianopia (if ophthalmic cortex is involved)
• May be bilateral visual impairment
• May be hemiparesis, hemisensory symptoms, diplopia, vertigo, vomiting, dysarthria, dysphagia or ataxia
• Ask about weakness, facial drooping, gait disturbance, confusion, memory loss, dysarthria or abnormal behaviour
• Check for simultaneous cardiac symptoms (e.g. palpitations)

Question 8

Signs of TIA:

Answer 8

Usually a neuro exam will be normal

Pulse to look for AF

Auscultate the carotids to hear for bruits - carotid atherosclerosis

Question 9

Investigations:

Answer 9

•	Primary Care Investigations
o	Urinalysis (check for glycosuria)
o	FBC 
o	U&Es
o	Lipids 
o	LFTs
o	TSH 
o	ECG (may show AF or previous MI)

Secondary Care
o Unenhanced CT - if there is a possibility of a haemorrhage (e.g. if the patient is anticoagulated or has a bleeding disorder)

Investigate for Source of Emboli
o ECG (24 hr tape or cardiac monitoring may be considered if paroxysmal atrial fibrillation is suspected)
o Doppler ultrasound of carotid (+/- angiography) and vertebral arteries

Question 10

Management:

Answer 10

300 mg aspirin immediately and assessed urgently within 24 hrs
• Patients with confirmed TIA should receive:
o Clopidogrel - 300 mg loading dose and 75 mg thereafter
o High-Intensity Statin Therapy - e.g. atorvastatin 20-80 mg
• Secondary Prevention
o Antiplatelets
o Antihypertensives
o Lipid-modifying treatments
o Management of AF
o Warfarin if cardiac emboli present
o Cardiac endarterectomy if >70% stenosis at origin of ICA and operative risk is good
o Avoid driving for 1 month

ABCD2 Score calculated to see risk of stroke (age, BP, clinical features, duration and T2DM)

Question 11

Complications:

Answer 11

Stroke

Recurrence

Question 12

Prognosis:

Answer 12

very high risk of stroke especially in the first month and up until the first year afterwards

ABCD2 score to see the risk of a stroke afterwards