Transient Ischaemic Attack Flashcards
What is a TIA?
Rapidly developing focal disturbance of brain function of presumed vascular origin that resolves completely within 24h.
Describe the aetiology of a TIA
Usually EMBOLIC but may be thrombotic
Where is the most common site emboli in TIA’s arise from? Where else can they arise from?
CAROTID atherosclerosis
The heart: AF, Mitral valve disease + Atrial myxoma
List 10 risk factors for TIA
HTN Smoking DM Heart disease (valvular, ischaemic, AF) Peripheral arterial disease Polycythaemia rubra vera Hyperlipidaemia Clotting disorders OCP Alcohol
Summarise the epidemiology of TIAs
More common with increasing age
M > F
15% of stroke patients have experienced a previous TIA
If a TIA affects the carotid territory, what symptoms present?
Unilateral Mostly affect MOTOR AREA: weakness in arm, leg or 1 side of face Dysarthria Broca's aphasia Amaurosis fugax
If a TIA affects the vertebrobasilar territory, what 9 symptoms may be present?
Homonymous hemianopia Hemiparesis Hemisensory Sx Diplopia Vertigo Vomiting Dysarthria Dysphagia Ataxia
What symptoms would you ask a patient that has potentially had a TIA about?
Duration, intensity + fluctuation of Sx. Weakness Facial drooping Gait disturbance Confusion/ memory loss Dysarthria Abnormal behaviour Simultaneous cardiac Sx (e.g. palpitations)
Define Amaurosis fugax
painless fleeting loss of vision caused by retinal ischaemia
What are the clinical signs of TIA?
Neuro exam may be NORMAL because TIA may have resolved by the time you do it
Check pulse for irregular rhythm (AF)
Auscultate carotids for bruits (carotid atherosclerosis)
What basic investigations are used for TIA?
FBC (infection, polycythaemia) U+Es (electrolyte imbalance) Lipids Glucose: Hypoglycaemia = TIA mimic Troponin (Acute MI) Coagulation panel ECG (AF or previous MI)
What secondary care investigation for TIA may be carried out? Why?
Non contrast CT
If possibility of a haemorrhage (e.g. if pt is anticoagulated or has a bleeding disorder)
What investigations may be performed to identify the source of embol after a TIA?
ECG (24h tape if paroxysmal AF is suspected)
Doppler US of carotid + vertebral arteries
How should patients with acute neurological symptoms that resolve completely within 24 hrs be treated?
300mg aspirin immediately
Assess urgently within 24 hrs
What should patients with confirmed TIA receive?
Clopidogrel: 300mg loading dose + 75mg thereafter
Atorvastatin 20-80 mg
What 4 secondary prevention measures can be used in TIA?
Antiplatelets
Antihypertensives
Statins
Management of AF
What scoring system is used to assess risk of future TIA?
ABCD2 score Age >60y BP >140/90 Clinical features: unilateral weakness, speech disturbance Duration of Sx Diabetes
What are 2 possible complications of TIA?
Recurrence
Stroke
What is the prognosis of patients with a TIA?
VERY HIGH RISK of STROKE in 1st month after + up to 1y afterwards
