Transient ischaemic attacks (TIA)

Question 1

Define TIA

Answer 1

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

Question 2

Aetiology of a TIA

+ source

Answer 2

Usually embolic but may be thrombotic

Sources:
Most commonly from carotid atherosclerosis
Heart also - AF, mitral valve disease, atrial myxoma

Question 3

Risk factors for TIA

10

Answer 3

Hypertension
Smoking
Diabetes mellitus
Heart disease (AF, valvular, ischaemic)
Peripheral artery disease
Polycythaemia rubra vera
COCP
Hyperlipidaemia
Alcohol
Clotting disorders

Question 4

Epidemiology of TIA

age & gender

Answer 4

More common with increased age

More common in men

Question 5

Presenting symptoms of TIA - History

Answer 5

Usually last 10-15 mins

can be up to 24hrs

Question 6

Presenting symptoms of TIA - Clinical features
2 territories (5 & 1+)

Answer 6

Carotid territory
unilateral
most often affecting motor area (weakness in arm/leg/on side of face)
dysarthria
Broca’s dysphasia
Amaurosis fugal 

Vertebrobasilar territory

homonymous hemianopia

May be:
bilateral visual impairment 
hemiparesis
hemisensory symptoms
diplopia
vertigo
vomiting 
dysarthria
dysphagia
ataxia

Ask about:
weakness
facial drooping
gait disturbance
confusion
memory loss
dysarthria
abnormal behaviour 

Check for simultaneous cardiac symptoms (e.g. palpitations)

Question 7

Signs of TIA on examination

finding + 2 checks

Answer 7

Neuro exam may be normal

Check pulse for irregular rhythm (AF)

Auscultate the carotids to check for bruits (carotid atherosclerosis)

Question 8

Investigations for TIA - Primary care

7

Answer 8

Urinalysis (glycosuria check)
FBC
U&Es
Lipids
LFTs
TSH
ECG - may show AF/prev MI

Question 9

Investigations for TIA - Secondary care

Answer 9

Unenhanced CT

Question 10

Investigations for TIA - Source of emboli

2

Answer 10

ECG

Doppler US of carotid & vertebral arteries

Question 11

Management of TIA

general, confirmed x2, secondary prevention x4

Answer 11

ANY patient presenting with acute neurological symptoms that resolve completely within 24hrs should be given 300mg aspirin immediately & assessed urgently within 24hrs

Clopidogrel - 300mg loading dose & 75mg thereafter
High intensity statin therapy (e.g. atorvastatin 20-80mg)
Assessment of future stroke risk in TIA patients = ABCD2 score

Antiplatelets
Antihypertensives
Lipid modifying treatments
Management of AF

Question 12

Complications of TIA

2

Answer 12

Recurrence

Stroke

Question 13

Prognosis of TIA

Answer 13

VERY HIGH risk of stroke in 1st month after TIA & up to 1 year after