Transient Ischaemic Attacks

Question 1

Transient ischaemic attacks (TIA) are brief periods of neurological deficit due to a vascular cause. What is the incidence of TIAs?

1 - 2300 cases per 100,000
2 - 230 cases per 100,000
3 - 23 cases per 100,000
4 - 2.3 cases per 100,000

Answer 1

2 - 230 cases per 100,000

Slightly more common in men

Question 2

Transient ischaemic attacks (TIA) are brief periods of neurological deficit due to a vascular cause. What age does the incidence of TIAs peak?

1 - 30-40
2 - 40-50
3 - 50-60
4 - >70

Answer 2

4 - >70

Question 3

What % of people who have a stroke has previously been preceded by a transient ischemic attack?

1 - 10%
2 - 20%
3 - 50%
4 - 75%

Answer 3

2 - 20%

Question 4

Typically how long do transient ischaemic attacks last?

1 - <30 mins
2 - <1 hour
3 - <3 hours
4 - <4.5 hours

Answer 4

2 - <1 hour

Question 5

Typically transient ischaemic attacks (TIA) last <1 hour. But to be a TIA, how long must the symptoms last for?

1 - <30 mins
2 - <1 hour
3 - <24h hours
4 - <72 hours

Answer 5

3 - <24h hours
Typically symptoms last minutes to 1 hour

• > 24 hours is a full stroke
• loss of function can be focal (specific part of brain) cerebral for ocular (eye) and then relieve itself

This is has changed to be a stroke even if <24h if there is confirm brain damage on imaging

Question 6

All of the following can cause transient ischaemic attacks, but which is the most common cause?

1 - Embolism
2 - Lacunar (small vessel disease)
3 - Haemodynamic compromise
4 - all equally likely

Answer 6

1 - Embolism

Foreign material travelling around body in blood (blood clots, fat emboli etc.)

Question 7

2 - Lacunar transient ischaemic attacks (TIAs) are commonly associated with small vessel disease. Do these cause motor or sensory deficits?

Answer 7

• can cause both

Question 8

All of the following regions of the brain can be affected by Lacunar transient ischaemic attacks (TIAs), but which is least likely?

1 - basal ganglia
2 - thalamus
3 - internal capsule
4 - cerebellum
5 - brainstem

Answer 8

4 - cerebellum

Question 9

The location of the transient ischaemic attacks (TIAs) ultimately affects the symptoms the patient presents with. Which of the following can present following a TIA?

1 - unilateral weakness
2 - unilateral sensory loss
3 - dysarthria or aphasia
4 - ataxia / vertigo / balance
5 - all of the above

visual problems
sudden transient loss of vision in one eye (amaurosis fugax)
diplopia
homonymous hemianopia

Answer 9

5 - all of the above

Question 10

The location of the transient ischaemic attacks (TIAs) ultimately affects the symptoms the patient presents with. This can include visual problems including all of the following, EXCEPT which one?

1 - papilledema
2 - diplopia
3 - transient loss of vision (amaurosis fugax)
4 - homonymous hemianopia

Answer 10

1 - papilledema

Associated with ICP

Question 11

Transient ischaemic attacks can cause vision changes. Which of the following describes the image below?

left eye = lateral loss
right eye = medial loss

1 - Bitemporal Homonymous Hemianopia
2 - Left Homonymous Hemianopia
3 - Superior Homonymous Quadrantanopia
4 - Left Inferior Homonymous Hemianopia

Answer 11

2 - Left Homonymous Hemianopia

Lesion would be in optic track after the optic chiasm

Question 12

When should a head CT be performed in patients with a TIA?

1 - when focal symptoms are unilateral
2 - when patient is distressed
3 - clinical suspicion of alternative diagnosis than TIA
4 - aged >65

Answer 12

3 - clinical suspicion of alternative diagnosis than TIA

Question 13

MRI including diffusion-weighted and blood-sensitive sequences is the imaging of choice in transient ischaemic attacks. However, according to NICE when should they be performed?

1 - same day as physical assessment of patient
2 - to identify territory of ischaemia
3 - to detect haemorrhage or alternative pathologies
4 - all of the above

Answer 13

4 - all of the above

Question 14

What imaging method should all patients receive who have had a transient ischaemic attack and considered as a candidate for carotid endarterectomy (atherosclerosis is most common cause) receive?

1 - ultrasound
2 - head CT
3 - carotid imaging
4 - head MRI

Answer 14

3 - carotid imaging

Should be done urgently

Carotid endarterectomy involves opening the artery and removing the plaque

Question 15

To identify those patients at risk of a stroke following a transient ischaemic attack (TIA), the ABCD2 score can be used. Which of the following is NOT used in this score?

1 - age >60
2 - history of diabetes
3 - atrial fibrillation
4 - duration of symptoms during TIA
5 - BP >140/90 mmHg
6 - clinical features of TIA

Answer 15

3 - atrial fibrillation

ABCD2 is no longer recommended by NICE due to poor performance in studies

Question 16

Which antithrombotic medication should be given to all patients who have had a suspected TIA while they await specialist consultation?

1 - clopidogrel
2 - heparin
3 - abciximab
4 - aspirin

Answer 16

4 - aspirin

Given at a dose of 300mg immediately

Question 17

300mg aspirin should be given to all patients who have had a suspected TIA, except in which of the following?

1 - patient has bleeding disorder or is taking an anticoagulant
2 patient is already taking low-dose aspirin regularly (continue current dose of aspirin until reviewed by a specialist)
3 - contraindicated following specialist review
4 - all of the above

Answer 17

4 - all of the above

Question 18

Which of the following require specialist review?

1 - patient has had more than 1 TIA or has a suspected cardioembolic source or severe carotid stenosis
2 - suspected TIA in the last 7 days
3 - suspected TIA which occurred more than a week previously (seen in 7 days)
4 - all of the above

Answer 18

4 - all of the above

Question 19

Following a TIA, are patients ok to drive?

Answer 19

• No

Should stop driving until they have had a specialist review, typically not to drive for 30 days following a TIA

Question 20

Once a patient has been confirmed as having a TIA, secondary prevention should be started. Following the initial 300mg of aspirin, what is the 1st line medication for patients?

1 - clopidogrel
2 - aspirin
3 - aspirin + dipyridamole
4 - dipyridamole + clopidogrel

Answer 20

1 - clopidogrel

This is the same as if patients have had a stroke

• aspirin + dipyridamole can be given if patient cannot tolerate clopidogrel

Question 21

Once a patient has been confirmed as having a TIA, secondary prevention should be started. High-intensity statin (such as atorvastatin 20–80 mg daily) should be started to reduce non-HDL cholesterol. What is the target for lowering non-HDL cholesterol?

1 - >5%
2 - <10%
3 - >20%
4 - >40%

Answer 21

4 - >40%

Question 22

Patients should be offered carotid artery endarterectomy if what % of carotid artery stenosis is present according to the European Carotid Surgery Trialists’ Collaborative Group?

1 - >20%
2 - >40%
3 - >50%
4 - >70%

Answer 22

4 - >70%

This is 50% according to the North American Symptomatic Carotid Endarterectomy Trial criteria