(!) Transient ischemic attacks Flashcards
What is a TIA? And RF
TIA is a transient ischemic attacks- defined as ACUTE ONSET stroke like neuro symptoms lasting for less than 24h
due to focal brain, spinal cord or even retinal ischemia– often a precursor to a CVA
RF–Same as stroke
htn htn and HTN
but also smoking, obesity, familiy history, contraception, blood clots etc
Signs and sx of TIA
Classical stroke presentation-
Suddent onset-
Unilateral limb and face weakness (while UMN, acute feels more LMN)
Dysphagia, vision changes (diplopia, hemianopia) gait changes
vertigo
History for heart disease, or anticoagulant use (important)
use ROSIER scale to determine likelyhood of stroke/TIA but dont use to determine referal!
Ix of TIA
Main Ix is to be done after initial management
Initial Ix-check differentials-
blood glucose
FBC, INR, electrolytes
ECG for AF
CT is not reccomended if not suspicion of other diagnostic,
DO CT if ddx possible or on anti-coagulant
MRI after seen by specialist can help determine location
CAROTID imaging urgent for everyone that needs it
surgery if over 70% stenoses/symptoms
Management of TIA
Immediate 300mg (loading) Aspirin should be started
with PPI cover
(except if already on aspirin, on other anti coagulants -> (CT for bleed), or intolerant (clopidogrel)
dont drive!
if in past 7 days—refered to be seen by specialist within 24h
if before 7 days- seen within a week
then do the MRI/Carotid scans
long term-
add clopidogrel 75mg - dual anti plt for rest of life
Statin max dose
treat underlying AF/HTN/T2DM
Prognosis/complications of TIA
High risk of stroke-especially in the early post tiA period- half in the first month
10% of TIA people have strokes later
also risk of MI
