Transient ischaemic attack Flashcards
What is a TIA
acute neurological deficit due to a vascular cause which typically lasts less than an hour- RESOLVES WITHIN 24HRS
How may a patient with a TIA present
similar to stroke but features resolve typically within an hour
- unilateral weakness/sensory loss
-aphasia/dysarthria
-ataxia, vertigo, or loss of balance - visual problems
sudden transient loss of vision in one eye
diplopia
homonymous hemianopia
What do NICE recommend when someone has a TIA
immediate antithrombotic therapy -
ASPIRIN 300MG daily
When should aspirin 300mg daily not be given
- if patient has a bleeding disorder or is taking an anticoagulant- need immediate imaging to exclude a haemorrhage
- patient already takes low dose aspirin regularly
- aspirin is contraindicated
When is a specialist review needed urgently
if patient has had more than 1 TIA or has suspected cardioembolic source or severe carotid stenosis
When can assessment be done within 24 hours
if patient has had a suspected TIA in last 7 days
When can specialist assessment be done within 7 days
If patient has had a suspected TIA which occurred more than a week previously
What is first line investigations
Neuroimaging
-MRI done on same day as specialist assessment if possible
CT NOT TO BE DONE
What other imaging should be done
Carotid imaging
- atherosclerosis in carotid artery may be source of emboli in some patients
all patients should have urgent carotid doppler
What is next management step for TIA
antiplatelet therapy to follow on from initial aspirin
CLOPIDOGREL
- DIPYRIDAMOLE for those who cannot tolerate clopidogrel
What lipid modification therapy should be given
high intensity statin
-ATORVASTATIN 20-80 mg daily
When should a carotid artery endarterectomy be considered
if carotid stenosis >70%
OR
>50%
recommended if patient has suffered stroke or TIA in carotid territory and is not severely disabled
