Transient Ischaemic Attack

Question 1

What is the NEW definition of a TIA?

Answer 1

‘Tissue-based’
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

Question 2

What was the old definition of a TIA?

Answer 2

A sudden onset of a focal neurological symptom and/or sign lasting <24 hours, brought on by a transient decrease in blood flow.
(Changed to recognise tissue-based pathological changes to the brain)

Question 3

What prognostic score was previously used to risk stratify patients who presented with suspected TIA?

Answer 3

ABCD2 (No longer NICE recommended)

Question 4

What is the acute/immediate management of TIA?

Answer 4

Immediate antithrombotic therapy with 300mg aspirin unless:

The patient has a bleeding disorder or is taking an anticoagulant - immediate admission for imaging
Already taking low-dose aspirin
Aspirin is contraindicated

Question 5

When would you consider admission and observation with a stroke specialist?

Answer 5

Cresendo TIA ‘more than one’
Suspected cardioembolic source
Severe carotid stenosis

Question 6

What is the management plan if the patient has had a suspected TIA in the last 7 days?

Answer 6

Arrange urgent assessment within 24 hrs by specialist stroke physician

Question 7

What is the management plan if the patient has had a suspected TIA > 7 days ago?

Answer 7

Refer for specialist assessment as soon as possible within 7 days.

Question 8

What is the driving advice with regards to TIA?

Answer 8

Advice not to drive until have been reviewed by a specialist

Question 9

What is the long term/further management of TIA?

Answer 9

Antithromotic therapy - Clopidogrel (same as stroke)
(Aspirin + dipyridamol if CI)

If in carotid territory and >70% stenosis and suitable - Carotid artery endarterectomy