Transient ischaemic attacks

Question 1

TIA

Answer 1

Transient period of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

Question 2

Clinical features

Answer 2

Unilateral weakness or sensory loss

Aphasia or dysarthria

Ataxia, vertigo, loss of balance

Visual problems- sudden loss of vision (amaurosis fugax), diplopia, homonymous hemianopia

Question 3

Immediate treatment

Answer 3

300mg aspirin immediately unless
- bleeding disorder/ taking an anticoagulant
- already taking low-dose aspirin regularly
- aspirin contraindicated

Question 4

When to have specialist review

Answer 4

More than 1 TIA or suspected cardioembolic source or severe carotid stenosis (discuss admission/ observe)

Suspected TIA in the last 7 days (arrange urgent specialist assessment)

Suspected TIA more than a week previously (specialist assessment within 7 days)

Question 5

Neuroimaging

Answer 5

MRI preferred to CT to determine territory of ischaemia, detect haemorrhage or alternative pathologies

Should be done same day as specialist assessment if possible

Question 6

Carotid imaging

Answer 6

All patients should have urgent carotid doppler unless not a canditate for carotid endarterectomy

Question 7

Further management

Answer 7

Clopidogrel recommended first line

Aspirin + dipyridamidole if can’t tolerate clopidogrel

Question 8

Carotid artery endarterectomy

Answer 8

If patient suffered stroke of TIA in carotid territory and are not severely disabled

Should only be considered if stenosis >70% (ECST criteria) or >50% (NASCET criteria)