TIA (Transient Ischemic Attack)

Question 1

What is a TIA?
Onset?
What does it affect?
How long does it last?

Answer 1

Brief period of ischemia due to emboli = impaired perfusion to the brain

Sudden Onset

Focal Neurological deficit
Temporary

Sx typically 5-15mins, <1hr
>24hr WITHOUT INFARCTION

Question 2

Which arteries are affected by TIAs?
What %?

Answer 2

90% = Internal carotid artery (anterior circulation)

10% = Vertebral (posterior)

Question 3

Causes of TIA?

Answer 3

Carotid thrombo-emboli
-Thrombosis
-Emboli eg. from AF

Question 4

RF for TIA?

Answer 4

Same as IHD, Smoking, htn, T2DM, *AF, obesity, hypercholesterolemia, *VSD (Ventricular septal defect)

Question 5

Sx of TIA?
Which areas of brain/arteries can be affected?

Answer 5

Focal neurology
ACA (anterior cerebral)
MCA (Middle Cerebral)
Amaurosis fugax
Posterior cerebral artery
Vertebral artery

Question 6

A TIA in the ACA causes what Sx?

Answer 6

Weak numb contralateral leg

Question 7

A TIA in the MCA causes what Sx?

Answer 7

Weak numb contralateral side of body
Face drooping with FOREHEAD SPARED
dysphasia (partial loss of language) - temporal

Question 8

What is Amaurosis fugax?
Which arteries and part of body is affected?
Why is it a bad sign?

Answer 8

Transient loss of vision to one or both eyes

Due to occlusion/decreased blood flow to retina through retinal, ophthalmic and ciliary artery

BAD SIGN = Often signals stroke is impending

Question 9

A TIA in the Posterior cerebral artery causes what Sx?

Answer 9

Vision loss
Contralateral homonymous hemianopia with macular sparing - occipital cortex affected

Question 10

A TIA in the vertebral artery causes what Sx?

Answer 10

Cerebellar syndrome (DANISH) with +ve Romberg test (sensory and motor ataxia)
Brain stem infarct
CN lesions 3-12

Question 11

When can you differentiate a TIA from a stroke?

Answer 11

Can’t differentiate until after recovery

TIA = Sx resolve within mins usually, always <24hrs with no infarct

Stroke = Sx last 24hrs with infarct

Question 12

How is a diagnosis made for TIA?

Answer 12

Clinically made, usually obvious if TIA/Stroke suspected
Scoring system

Question 13

What are the 2 scoring systems and what do they stand for?

Answer 13

FAST = Face, Arms, Speech, Time (v.effective PH campaign)

ABCD2
Age >60 (1)
BP >140/90 (1)
Clinical Sx - Unilateral weakness (2) or slurred speech with no weakness (1)
Duration - >1hr (2) or <1hr (1)
DMT2 (1)
Scores 6+ = refer to neurology ASAP (35.5% risk within a week)

Question 14

Tx for TIA?

Answer 14

Acutely = Aspirin 300mg
Prophylaxis long term = Clopidogrel 75mg and Atorvastatin 80mg