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Flashcards in FN: TIAs Deck (14):
1

Definition

1. Sudden onset focal neurology lasting

2

Signs

1. Symptoms usually brief
2. Global events (e.g. syncope, dizziness) are not typical
3. Signs mimic those of CVA in the same arterial territory

3

Signs of Causes

Carotid bruits
raised BP
HEart murmur
AF

4

Causes

1. Atherothromboembolism form carotids in main cause
2. Cardioembolism: post-MI, AF, valve disease
3. Hyperviscosity: polycythaemia, SCD, myeloma

5

Differential

Vascular: CVA, migraine, GCA
Epilepsy
Hyperventilation
Hypoglycaemia

6

Investigations

Aim to find cause and define vascular risk
bloods: FBC, U&E, ESR, glucose, lipids
CXR
ECG
Echo
Carotid doppler ± angiography
Consider brain imaging - diffusion weighted MRI is best

7

Management

ACAS
1. Time to intervention is crucial
a. intervention w/i 72hrs - 2% strokes @ 90d
b. Intervention w/i 3 wks - 10% strokes @ 90d

2. Avoid driving

8

Medical treatment

Antiplatelet therapy/Anticoagulate
1. Aspirin/clopi 300mg/d for 2 wks then 75mg
2. Warfarin if cardiac emboli: AF, MI, MS - after 2 weeks

9

Cardiac risk factor control

BP, lipids, DM, smoking
Excercise
Diet: reduce salt

10

Assess risk of subseqeunt stroke

ABCD2 score

11

Specialist referral to TIA clinic

ABCD2 >4 w.i 24 hrs
ABCD2

12

Carotidendarerectomy

1. beneficial if >70% symptomatic stenosis
2. 50-70% stenosis may benefit if operative risk is

13

Prognosis

Combined risk of stroke and MI is 9% yr
3x raise in mortality cf TIA-free populations

14

ABCD2 Score

Age >60
BP >140/90
Clinical features
a. Unilateral weakness (2 points)
b. Speech disturbance w/o weakness
Duration >1h (2 points)
10-59 min
DM

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