TIA

Question 1

definition

Answer 1

A transient ischaemic attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. The majority of TIAs resolve within the first hour, and diagnostic imaging allows recognition that some events with rapid clinical resolution are associated with permanent cerebral infarction. The arbitrary definition of duration of symptoms for TIA should not deter aggressive therapy for a patient who presents with new neurological deficit.

By definition TIA symptoms are brief and the majority will resolve within the first hour.

Persistent symptoms at presentation should be treated as stroke, and therapy should not be delayed in the hope of spontaneous recovery.

Question 2

symptoms

Answer 2

• focal neurological deficit

-

Question 3

risk factors

Answer 3

PMH:

• extra cranial atherosclerosis
• cardiac disease
• migraine
• carotid bruit (carotid artery stenosis)
• a fib
• valvular disease
• hypertension
• DM
• smoking
• alcohol abuse

(- patent foramen oval => PE -> stroke)

FHX

Question 4

investigations

Answer 4

1st investigations:

• FBC
• blood glucose
• chemistry profile
• aPTT, INR, PTT
• ECG
• brain MRI
• fasting lipid profile

Question 5

treatment

Answer 5

atherosclerotic or small vessel:
1. aspirin/clopidogrel
+ statin
++ ezetimibe (if statin not useful or at max but still LDL high)

if >50% carotid stenosis -> carotid endarterectomy

cardioembolic with/without IHD
1. warfarin
+ statin
++ ezetimibe

mechanical heart valve or rheumatic heart disease already on warfarin:
add aspirin (continue warfarin)