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 National Clinical Guideline for Stroke published in 2023?
The guideline recommends the use of dual antiplatelet therapy (DAPT).
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 was the original definition of a TIA?
The original definition was a sudden onset of focal neurologic symptom and/or sign lasting less than 24 hours due to a transient decrease in blood flow.
What is the new definition of a TIA?
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
What term do patients often use for TIAs?
Patients often refer to TIAs as ‘mini-strokes’.
What are common clinical features of a TIA?
Features include unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, visual problems, and sudden transient loss of vision in one eye.
What should be done for patients with suspected TIA?
They 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?
It 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 to detect haemorrhage or alternative pathologies.
What is the immediate management for TIA patients?
Patients should receive antiplatelet therapy unless contraindicated or at high risk of bleeding.
What are the DAPT regimes for TIA or minor ischaemic stroke?
Clopidogrel + aspirin or ticagrelor + clopidogrel are recommended for patients within 24 hours of onset.
What should be considered for patients on DAPT?
Proton pump inhibitor therapy should be considered.
What is the management approach for patients with atrial fibrillation after TIA?
They should be anticoagulated as soon as intracranial haemorrhage has been excluded.
What is the goal of lipid modification in TIA management?
To reduce non-HDL cholesterol by more than 40% using high-intensity statins.
What imaging should be performed for carotid assessment in TIA patients?
Carotid duplex ultrasound or either CT angiography or MR angiography should be performed within 24 hours of assessment.
When is carotid endarterectomy recommended?
It is recommended if the patient has suffered a stroke or TIA in the carotid territory and has stenosis > 50%.
Antithrombotic medications - 3 different phases
