Transient ischaemic attack Flashcards
What is a transient ischaemic attack (TIA)?
A TIA is a brief period of neurological deficit due to a vascular cause, typically lasting less than an hour.
What updated recommendation was made in the 2023 National Clinical Guideline for Stroke regarding TIA?
The guideline recommends the use of dual antiplatelet therapy (DAPT) for TIA.
Is DAPT recommended for ‘major’ ischaemic stroke?
No, DAPT is not currently recommended for ‘major’ ischaemic stroke due to the high risk of haemorrhagic transformation.
What is the original definition of a TIA?
The original definition was a sudden onset of a focal neurologic symptom lasting less than 24 hours due to a transient decrease in blood flow.
What is the new ‘tissue-based’ definition of a TIA?
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
What common term do patients often use for TIAs?
Patients often refer to TIAs as ‘mini-strokes’.
What are the clinical features of a TIA?
Clinical features include sudden onset focal neurological deficit that resolves typically within 1 hour.
What are some possible features of a TIA?
Possible features include unilateral weakness, aphasia, ataxia, visual problems, and sudden transient loss of vision (amaurosis fugax).
What should be done for patients with suspected TIA?
Patients should be given aspirin 300 mg immediately unless contraindicated and assessed urgently within 24 hours by a stroke specialist clinician.
What are examples of TIA mimics that require exclusion?
Examples include hypoglycaemia and intracranial haemorrhage.
What is the ABCD2 prognostic score?
The ABCD2 score was previously used to risk stratify patients with suspected TIA but is no longer recommended due to poor performance.
What imaging is recommended for patients with suspected TIA?
MRI is preferred to determine the territory of ischaemia or detect haemorrhage or alternative pathologies.
What is the immediate management for patients with TIA?
Patients should receive antiplatelet therapy unless contraindicated or at high risk of bleeding.
What are the DAPT regimes for patients within 24 hours of TIA onset?
Consider clopidogrel + aspirin or ticagrelor + clopidogrel, or clopidogrel alone if DAPT is not appropriate.
What should be done for patients with atrial fibrillation after TIA?
They should be anticoagulated as soon as intracranial haemorrhage has been excluded.
