TIA

Question 1

define a TIA?

Answer 1

transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction.

Question 2

what is the cause of a TIA?

Answer 2

• It is usually EMBOLIC but may be thrombotic

Question 3

where might emboli arise from?

Answer 3

•	Most common source of emboli = CAROTID atherosclerosis  
•	Emboli can also arise from the heart: 
o	Atrial fibrillation  
o	Mitral valve disease  
o	Atrial myxoma

Question 4

risk factors for TIAs?

Answer 4

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

Question 5

epidemiology of a TIA?

Answer 5

• More common with increasing age
• More common in men
• 15% of stroke patients would have experienced a previous TIA

Question 6

how long do TIAs last?

Answer 6

o TIAs usually last 10-15 mins (but can be anything from a few minutes to 24 hours)

Question 7

what are clinical features of TIAs in the carotid territory?

Answer 7

• 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

Question 8

what are clinical features of TIAs in the Vertebrobasilar Territory ?

Answer 8

• Homonymous hemianopia
• 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

Question 9

what should be checked on physical examination?

Answer 9

• Check pulse for irregular rhythm (AF)

* Auscultate the carotids to check for bruits

Question 10

what investigation should be done first for a TIA?

Answer 10

Blood sugar (hypoglycaemia can mimic a TIA) diabetics!

Question 11

what investigation should be done second?

Answer 11

o 2. CT head- if there is a possibility of a haemorrhage (e.g. if the patient is anticoagulated or has a bleeding disorder)

Question 12

how can the source of the emboli be investigated?

Answer 12

o	ECG (24 hr tape or cardiac monitoring may be considered if paroxysmal atrial fibrillation is suspected) 
o	Doppler ultrasound of carotid and vertebral arteries

Question 13

management for suspected TIA?

Answer 13

o Give 300mg of aspirin immediately
UNLESS:
o the patient is taking an anticoagulant/has bleeding disorder
o the patient is taking low dose aspirin regularly
o aspirin is contraindicated

Question 14

what should you do if the patient has had more than 1 TIA?

Answer 14

admit or observe with stroke specialist

Question 15

what should you do if the patient has had a TIA in the last 7 days ?

Answer 15

arrange assessment within 24hrs by specialist stroke physician and give 300mg of aspirin

Question 16

what is long term treatment?

Answer 16

• Clopidogrel is first line

Question 17

when should carotid endarterectomy be performed?

Answer 17

• Carotid artery endarterectomy should be given to those who have a TIA with carotid artery stenosis exceeding 70%

Question 18

what are the complications of a TIA?

Answer 18

• Recurrence

* Stroke

Question 19

prognosis of a TIA?

Answer 19

• VERY HIGH RISK of STROKE in the first month after the TIA and up to 1 year afterwards