Transient Ischaemic Attack Flashcards
define TIA
temporary, focal cerebral ischaemia that results in reversible neurological deficits without acute infarction
ie. imaging shows no signs on infarction
eatiological classification of TIA
cardioembolic
lacunar/small vessel disease
large vessel disease/low-flow state
blood disorders/hypercoagulable states
clinical features - neurological manifestations
acute, transient focal neurological symptoms
typically symptoms last <1 hour (the majority of cases resolve in <15 minutes)
possibly amaurosis fugax
amaurosis fugax
transient monocular or binocular loss of vision
causes include cardiovascular, ocular and neurological conditions
features of TIA that may suggest specific underlying cause
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
approach to TIA
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
labs for TIA
FBC, UECs, coags, troponin, serum lipids, HHbA1c
imaging for TIA
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
USS carotids
Holter monitor
antithrombotic therapy following TIA
within 24 hours and after ruling out ICH
aspirin
consider DAPT for short term therapy
anticoagulants indicated for specific underlying aetiologies eg. A Fib, usually not combined with antiplatelet therapy
risk of subsequent stroke after TIA
10% at two weeks
half of these events occur within 48 hours
neurovascular and cardiac studies following stroke
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
why do you need immediate serum glucose
to evaluate for DKA, HHS, or hypoglycaemia any of which have symptoms that may mimic TIA
surgical or intravascular intervention
indications include certain severe forms of carotid artery stenosis or cervical artery dissection
prognosis of TIA
increased risk of future ischaemic stroke
ABCD2 score
age >60
Blood pressure systolic >140 or diastolic >90
clinical features - unilateral weakness, isolated speech disturbance
Duration of TIA features >10 minutes
Diabetes
driving after TIA
set up outpatient follow up clinic
cannot drive until cleared by neuro
