TIA

Question 1

define a TIA

Answer 1

TIA’s are a sudden onset of neurological signs or symptoms due to temporary occlusion of part of cerebral circulation with resolution of symptoms/ signs within 24 hours

Question 2

what is the most common cause of TIA?

Answer 2

Carotid atheromatous disease

Question 3

outline the causes of TIA?

Answer 3

most common source of emboli - CAROTID ATHEROSCLEROSIS

Cardioembolism

• mural thrombus post MI or in AF
• Mitral valve disease
• Atrial myxoma
• prosthetic valve

clots from right side of the circulation can cause a stroke if there is a septal defect ( e.g. PFO- patent foramen ovale)

rare causes- hyperviscocity ( e.g. SCA, polycythaemia) and vasculitis

Question 4

what are the common causes of cardioembolism?

Answer 4

Mural thrombus post MI

AF

Mitral valve disease

Atrial myxoma

Prosthetic valve

Question 5

what are the risk factors for TIA?

Answer 5

○ Hypertension
○ Smoking 
○ Diabetes mellitus 
○ Heart disease (valvular, ischaemic, atrial fibrillation)
○ Peripheral arterial disease 
○ Polycythaemia rubra vera 
○ COCP
○ Hyperlipidaemia 
○ Alcohol
○ Clotting disorders 
Advancing age

Question 6

what is key about what you should do if someone presents with acute neurological symptoms that resolve within 24 hours?

Answer 6

TIA

-> Should be given 300mg aspirin imediately and assessed urgently within 24 hours

Question 7

what is key in a history of TIA

Answer 7

only last 10-15 mins ( but can be anything from few mins to 24 hours)

global events-> syncope and dizziness

clinical features depend on part of brain affected?

Question 8

what are the signs of TIA on physical examination?

Answer 8

may be normal as TIA may have resolve by the time

check for pulse irregular rhythm- AF

auscultate the carotids to check for bruits ( carotid atherosclerosis)

Question 9

what are the possible complications of TIA?

Answer 9

recurrence

stroke

Question 10

summarise the prognosis of patients with TIA?

Answer 10

very high risk of stroke first month after TIA and up to 1 years afterwards

Question 11

what are the investigations for a TIA?

Answer 11

blood glucose- check for hypoglycaemia as can be cause of focal symptoms which mimic TIA

FBC and platelets- should be normal

U and Es- extremely low K+ and Ca2+ cause generalised weakness

lipids- atherosclerotic risk

ECG- AF and myocardial ischaemia