Transient Ischaemic Attack

Question 1

What is a TIA?

Answer 1

An ischaemic neurological event with symptoms lasting <24h, they usually have an embolic cause and symptoms usually last a lot shorter than 24h

Question 2

What is the chief cause of TIAs?

Answer 2

Atherothromboembolism from carotid, listen for a carotid bruit

Question 3

What can cause hyperviscosity?

Answer 3

Polycythaemia, sickle-cell anaemia, myeloma

Question 4

What are clinical manifestations specific to?

Answer 4

Arterial territory involved

Question 5

What is unilateral progressive vision loss called in TIA?

Answer 5

Amaurosis fugax

Question 6

When does amaurosis fugax occur?

Answer 6

When retinal artery is occluded

Question 7

What type of events aren’t typical of TIAs?

Answer 7

Syncope, dizziness, temporary loss of consciousness, temporary memory loss, gradual onset

Question 8

What blood tests would you do?

Answer 8

FBC, ESR, U&E, glucose, cholesterol, INR if on warfarin

Question 9

What cardio tests would you do?

Answer 9

Carotid Doppler US +/- angiography, ECG, Echocardiogram

Question 10

What imaging would you do?

Answer 10

CT or diffusion-weighted MRI

Question 11

What are some common differential diagnoses?

Answer 11

Hypoglycaemia, migraine aura, focal epilepsy, retinal bleeds, vasculitis, syncope

Question 12

What cardiovascular risk factors should you control?

Answer 12

BP, smoking, statin

Question 13

What antiplatelet drugs should you start?

Answer 13

Loading aspirin dose of 300mg then aspirin 75mg daily or clopidogrel daily

Question 14

When should you start anticoagulation?

Answer 14

When patients have AF

Question 15

How long is driving prohibited for?

Answer 15

At least 1 month

Question 16

What scoring do you use to determine long term risk of stroke or CV events following TIA?

Answer 16

ABCD^2

Question 17

What does A stand for?

Answer 17

Age 60 or over

Question 18

What does B stand for?

Answer 18

Blood pressure 140/90 or higher

Question 19

What does C stand for?

Answer 19

Clinical features. Unilateral weakness, speech disturbance without weakness

Question 20

What does D stand for?

Answer 20

Duration of symptoms, Diabetes

Question 21

What other factors can increase a patients risk of future stroke?

Answer 21

AF, >1 TIA in a week, TIA while anticoagulated

Question 22

What are carotid territory symptoms?

Answer 22

Amaurosis fugax, aphasia, hemiparesis, hemisensory loss, hemianopia visual loss

Question 23

What are vertebrobasilar territory symptoms?

Answer 23

Diplopia, vertigo, vomiting, choking, dysarthria, ataxia, hemisensory loss, visual loss, tetraparesis

Question 24

When would you do a carotid endarterectomy?

Answer 24

If >70% carotid stenosis