Transient Ischaemic Attack

Question 1

Describe Tool ABCD2

Answer 1

A = Age > 60 years = 1 point

B = Blood pressure >= 140/90mmHg = 1 point

C = Clinical features:

• Unilateral weaknes = 2 point
• Speech disturbance, no weakness = 1 point

D = Duration of symptoms

• >60 minutes = 2 points
• 10-59 minutes = 1 point

D = Diabetes = 1 point

Question 2

If someone has a score of 4 or above what should be done?

Answer 2

They are at high risk of stroke.

• Aspirin (300mg daily) started immediately.
• Specialist assessment and investigation within 24 hours of onset of symptoms.
• Secondary prevention started as soon as the diagnosis is confirmed.
• Discussion of individual risk factors

Question 3

If someone has an ABCD2 risk score of 3 or below, what should be done?

Answer 3

1. Specialist assessment within 1 week of symptoms onset - including decision on brain imaging.
2. If vascular territory or pathology uncertain, refer for brain imaging.

Question 4

If someone is have crescendo TIAs how should they be treated?

Answer 4

They should be treated as high risk despite their score.

Question 5

What is first line treatment for people who have had a stroke?

Answer 5

Clopidogrel

Question 6

What is second line for patients who have had a stroke?

Answer 6

Aspirin + Dipyridamole

Question 7

When should someone have an artery endarterectomy?

Answer 7

• If patient has suffered stroke or TIA in the carotid territory and are not severely disabled.
• Should only be considered if carotid stenosis > 70% according ECST* criteria or > 50% according to NASCET** criteria

ECST = European

NASCET - North American