Transient Ischaemic Attack

Question 1

define TIA

Answer 1

temporary, focal cerebral ischaemia that results in reversible neurological deficits without acute infarction
ie. imaging shows no signs on infarction

Question 2

eatiological classification of TIA

Answer 2

cardioembolic
lacunar/small vessel disease
large vessel disease/low-flow state
blood disorders/hypercoagulable states

Question 3

clinical features - neurological manifestations

Answer 3

acute, transient focal neurological symptoms
typically symptoms last <1 hour (the majority of cases resolve in <15 minutes)
possibly amaurosis fugax

Question 4

amaurosis fugax

Answer 4

transient monocular or binocular loss of vision
causes include cardiovascular, ocular and neurological conditions

Question 5

features of TIA that may suggest specific underlying cause

Answer 5

palpitations, irregular heart rate = AF
carotid bruit = carotid rtery stenosis
fever, heart murmur, history of Iv drug use = endocarditis
chest pain, hypotension = aortic dissection
features of DVT = paradoxical embolism

Question 6

approach to TIA

Answer 6

establish clinical diagnosis
obtain immidiate ECG and point of care glucose
TIA diagnostics: lab studies, neuroimaging, cardiac evaluation within 24-48 hours
reduce subsequent stroke risk

Question 7

labs for TIA

Answer 7

FBC, UECs, coags, troponin, serum lipids, HHbA1c

Question 8

imaging for TIA

Answer 8

CT - non contrast CT head to rapidly rule out intracranial haemorrhage
MRI - more sensitive than CT for ischaemic stroke. diffuse n weighted imaging is preferred

Question 9

antithrombotic therapy following TIA

Answer 9

within 24 hours and after ruling out ICH
aspirin
consider DAPT for short term therapy
anticoagulants indicated for specific underlyign aetiologies eg. A Fib, usually not comobined with antiplatelet therapy

Question 10

neurovascular and cardiac studies following stroke

Answer 10

cardiac monitoring: eg. for arrythmias such as A Fib
echo: to look for cardiac thrombi, patent formamen ovale, cardiomyopathy
CT/MRI angiography or carotid doppler: possible findings: carotid artery stenosis, atherosclerotic lesion, embolic lesion, arterial dissection

Question 11

why do you need immediate serum glucose

Answer 11

to evaluate for DKA, HHS, or hypoglycaemia ass of which have symptoms that may mimic TIA

Question 12

surgical or intravascular intervention

Answer 12

indications include certain severe forms of carotid artery stenosis or cervical artery dissection

Question 13

prognosis of TIA

Answer 13

increased risk of future ischaemic stroke

Question 14

ABCD2 score

Answer 14

age >60
Blood pressure systolic >140 or diastolic >90
clinical features - unilateral weakness, isolated speech disturbance
Duration of TIA features >10 minutes
Diabetes