TIA Flashcards

1
Q

define a TIA?

A

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

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2
Q

what is the cause of a TIA?

A

• It is usually EMBOLIC but may be thrombotic

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3
Q

where might emboli arise from?

A
•	Most common source of emboli = CAROTID atherosclerosis  
•	Emboli can also arise from the heart: 
o	Atrial fibrillation  
o	Mitral valve disease  
o	Atrial myxoma
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4
Q

risk factors for TIAs?

A
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
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5
Q

epidemiology of a TIA?

A
  • More common with increasing age
  • More common in men
  • 15% of stroke patients would have experienced a previous TIA
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6
Q

how long do TIAs last?

A

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

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7
Q

what are clinical features of TIAs in the carotid territory?

A
  • 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
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8
Q

what are clinical features of TIAs in the Vertebrobasilar Territory ?

A
  • 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
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9
Q

what should be checked on physical examination?

A
  • Check pulse for irregular rhythm (AF)

* Auscultate the carotids to check for bruits

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10
Q

what investigation should be done first for a TIA?

A

Blood sugar (hypoglycaemia can mimic a TIA) diabetics!

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11
Q

what investigation should be done second?

A

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

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12
Q

how can the source of the emboli be investigated?

A
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
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13
Q

management for suspected TIA?

A

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

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14
Q

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

A

admit or observe with stroke specialist

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15
Q

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

A

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

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16
Q

what is long term treatment?

A

• Clopidogrel is first line

17
Q

when should carotid endarterectomy be performed?

A

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

18
Q

what are the complications of a TIA?

A
  • Recurrence

* Stroke

19
Q

prognosis of a TIA?

A

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