Transient Ischaemic Attack

Question 1

What is a TIA?

Answer 1

Rapidly developing focal disturbance of brain function of presumed vascular origin that resolves completely within 24h.

Question 2

Describe the aetiology of a TIA

Answer 2

Usually EMBOLIC but may be thrombotic

Question 3

Where is the most common site emboli in TIA’s arise from? Where else can they arise from?

Answer 3

CAROTID atherosclerosis

The heart: AF, Mitral valve disease + Atrial myxoma

Question 4

List 10 risk factors for TIA

Answer 4

HTN
Smoking  
DM
Heart disease (valvular, ischaemic, AF) 
Peripheral arterial disease  
Polycythaemia rubra vera  
Hyperlipidaemia  
Clotting disorders
OCP 
Alcohol

Question 5

Summarise the epidemiology of TIAs

Answer 5

More common with increasing age
M > F
15% of stroke patients have experienced a previous TIA

Question 6

If a TIA affects the carotid territory, what symptoms present?

Answer 6

Unilateral  
Mostly affect MOTOR AREA: weakness in arm, leg or 1 side of face  
Dysarthria 
Broca's aphasia  
Amaurosis fugax

Question 7

If a TIA affects the vertebrobasilar territory, what 9 symptoms may be present?

Answer 7

Homonymous hemianopia 
Hemiparesis
Hemisensory Sx
Diplopia
Vertigo
Vomiting
Dysarthria
Dysphagia
Ataxia

Question 8

What symptoms would you ask a patient that has potentially had a TIA about?

Answer 8

Duration, intensity + fluctuation of Sx.
Weakness
Facial drooping
Gait disturbance
Confusion/ memory loss
Dysarthria
Abnormal behaviour  
Simultaneous cardiac Sx (e.g. palpitations)

Question 9

Define Amaurosis fugax

Answer 9

painless fleeting loss of vision caused by retinal ischaemia

Question 10

What are the clinical signs of TIA?

Answer 10

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)

Question 11

What basic investigations are used for TIA?

Answer 11

FBC (infection, polycythaemia)
U+Es (electrolyte imbalance)
Lipids  
Glucose: Hypoglycaemia = TIA mimic
Troponin (Acute MI)
Coagulation panel 
ECG (AF or previous MI)

Question 12

What secondary care investigation for TIA may be carried out? Why?

Answer 12

Non contrast CT

If possibility of a haemorrhage (e.g. if pt is anticoagulated or has a bleeding disorder)

Question 13

What investigations may be performed to identify the source of embol after a TIA?

Answer 13

ECG (24h tape if paroxysmal AF is suspected)

Doppler US of carotid + vertebral arteries

Question 14

How should patients with acute neurological symptoms that resolve completely within 24 hrs be treated?

Answer 14

300mg aspirin immediately

Assess urgently within 24 hrs

Question 15

What should patients with confirmed TIA receive?

Answer 15

Clopidogrel: 300mg loading dose + 75mg thereafter

Atorvastatin 20-80 mg

Question 16

What 4 secondary prevention measures can be used in TIA?

Answer 16

Antiplatelets
Antihypertensives
Statins
Management of AF

Question 17

What scoring system is used to assess risk of future TIA?

Answer 17

ABCD2 score
Age >60y
BP >140/90
Clinical features: unilateral weakness, speech disturbance
Duration of Sx
Diabetes

Question 18

What are 2 possible complications of TIA?

Answer 18

Recurrence

Stroke

Question 19

What is the prognosis of patients with a TIA?

Answer 19

VERY HIGH RISK of STROKE in 1st month after + up to 1y afterwards