Transient Ischaemic Attack Flashcards
What is a TIA?
Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
Describe the aetiology of a TIA
Usually EMBOLIC but may be thrombotic
Where is the most common site emboli in TIA’s arise from? Where else can they arise from?
CAROTID atherosclerosis
The heart: AF, Mitral valve disease + Atrial myxoma
List 10 risk factors for TIA
HTN
Valvular Heart disease
Carotid stenosis
Congestive HF
AF
DM
Hyperlipidaemia
Hypercoaguable state/ vasculitis
Smoking
Alcohol
List 3 symptoms of total anterior circulatory TIA (Carotid territory)
Contralateral weakness
Dysphasia/ dysarthria (L sided cerebral hemisphere ischaemia)
Amaurosis fugax (ophthalmic branch of internal carotid)
Differentiate between anterior and middle cerebral artery occlusion symptoms
Anterior: contralateral leg > face + arm
Middle: contralateral face + arm > leg
List symptoms of posterior circulatory TIA (vertebrobasilar territory)
Bilateral motor +/or sensory deficit (vertebrobasillar)
Ataxia, Vertigo + loss of balance
Homonymous hemianopia
Diplopia
What symptoms would you ask a patient that has potentially had a TIA about?
Duration, intensity + fluctuation of Sx.
Weakness
Facial drooping
Gait disturbance
Confusion/ memory loss
Dysarthria
Abnormal behaviour
Simultaneous cardiac Sx (e.g. palpitations)
Define Amaurosis fugax
painless fleeting loss of vision caused by retinal ischaemia
What are the clinical signs of TIA?
Neuro exam may be NORMAL because TIA may have resolved by the time you do it
Check pulse for irregular rhythm (AF)
Auscultate carotids for bruits (carotid atherosclerosis)
What neuroimaging should be performed in suspected TIA?
MRI (inc. diffusion-weighted + blood-sensitive sequences) is preferred to determine territory of ischaemia, detect haemorrhage or alternative pathologies (same day as specialist assessment if possible)
NOT CT head ‘unless clinical suspicion of an alternative dx that CT could detect’
What investigations may be performed to identify the source of emboli after a TIA?
ECG (24h tape if paroxysmal AF is suspected)
Carotid doppler (Atherosclerosis in carotid may be source)
Describe management of patients who have presented within 7 days of a suspected TIA
300mg Aspirin immediately
Specialist review
List 3 contraindications to immediate Aspirin in suspected TIA
Bleeding disorder/ taking anticoagulant (needs immediate admission for imaging to r/o haemorrhage)
Already taking low-dose aspirin regularly: continue current dose until reviewed by specialist
Aspirin CI: discuss Mx urgently with specialist team
Describe management if patient has had >1 TIA (‘crescendo TIA’), or suspected cardioembolic source or severe carotid stenosis
Discuss the need for admission or observation urgently with a stroke specialist
