TIA

Question 1

What is a TIA?

Answer 1

Transient ischaemic attack: brief episode of neurological dysfunction due to temporary focal cerebral ischaemia without infarction

Question 2

What do TIA’s have the same underlying cause as?

Answer 2

Strokes

Question 3

What is the main cause of a TIA?

Answer 3

Atherothromboembolism from carotid

Question 4

What are 3 risk factors for a TIA?

Answer 4

• Age (risk increases with age)
• Hypertension
• Smoking
• Diabetes
• Heart disease
• Past TIA
• Raised packed cell volume (PCV)
• Peripheral arterial disease
• Polycythaemia vera
• Combined oral contraceptive pill (increase risk of clots)
• Hyperlipidaemia
• Excess alcohol
• Clotting disorder
• Vasculitis (eg SLE, giant cell arteritis) (rare)

Question 5

How does a TIA present?

Answer 5

SUDDEN loss of function, usually lasting for minutes only, with complete recovery and no evidence of infarction on imaging

Question 6

Where do 90% of all TIAs affect?

Answer 6

The anterior circulation (the carotid artery)

Question 7

What area of the carotid artery supply?

Answer 7

Frontal and medial part of the cerebrum

Question 8

What are occlusions in the carotid artery likely to cause?

Answer 8

• Numb CONTRALATERAL leg +/- similar, milder, arm symptoms
• Hemiparesis - weakness on an entire side of the body
• Hemisensory disturbance
• Dysphasia (language impairment)
• Amaurosis fugax (Sudden transient loss of vision in one eye)

Question 9

Which artery do 10% of TIA’s affect?

Answer 9

Vertebrobasilar artery

Question 10

Which part of the circulation does the vertebrobasilar artery supply?

Answer 10

The posterior circulation

Question 11

What can occlusion in the posterior circulation cause?

Answer 11

• Diplopia (double vision)
• Vertigo - the feeling that the surroundings are moving
• Vomiting
• Choking and dysarthria (unclear articulation of speech but understandable)
• Ataxia - no control of body movement
• Hemisensory loss
• Hemianopia - vision loss
• Loss of consciousness (rare)
• Transient global amnesia - episode of confusion / amnesia lasting several hours, followed by complete recovery
• Tetraparesis - muscle weakness affecting all 4 extremities

Question 12

What investigations would you do in a suspected TIA?

Answer 12

• Bloods:
• Carotid artery doppler ultrasound - look for stenosis / atheroma
• MRI/CT angiography if stenosis to determine extent
• ECG - look for AF or evidence of MI ischaemia
• CT or diffusion weighted MRI
• Echocardiogram/cardiac monitoring to assess for a cardiac cause

Question 13

What is the ABCD2 score?

Answer 13

Assesses the risk of a stroke following a TIA?

Question 14

What do the letters in the ABCD2 score stand for?

Answer 14

A - Age 
B - Blood pressure 
C - Clinical symptoms 
D - Duration of symptoms 
D - Diabetes

Question 15

What does a score of >6 suggest on the ABCD2 score?

Answer 15

That the person is at high risk of having a stroke and needs to be seen by a specialist immediately

Question 16

What pharmacological treatment is available for TIA’s?

Answer 16

• Antiplatelet drug
• Aspirin immediately + dipyridamole (increase cAMP and decrease thromboxane A2) for 2 weeks then lower dose
  P2y12 inhibitor long term eg clopidogrel
• Anticoagulant if they have AF, mitral stenosis or recent big septal MI eg warfarin
• Statin long term eg Simvastatin (lower the level of low-density lipoprotein (LDL) cholesterol in the blood)
• Control Cardiovascular risk factors
• Antihypertensives such as ACEI (eg ramipril) or ATR blocker (eg candesartan)
  Improve diet, stop smoking