TIA

Question 1

Definition of TIA

Answer 1

transient neurological deficit lasting less than 24h and normally less that 1h, caused by temporary occlusion of cerebral circulation and resulting in no cortical death.

Question 2

Causes of TIA

Answer 2

Atherthromboembolism = most common

Cardioembolism = mural thrombus post MI, AF, valve disease, prosthetic valves

Hyperviscosity = polycythemia, elevated WCC, myeloma

Question 3

History and Exam findings

Answer 3

As per stroke territories
Global events are not typical such as syncope or dizziness
Amaurosis fugax (progressive loss of vision in one eye)
Carotid bruit, measure BP, listen for murmurs, AF

Question 4

Differential Diagnosis

Answer 4

hypoglycaemia 
migrane with aura 
focal epileptic seizure 
syncope and hypotension 
hyperventilation 
vertigo +/- secondary nausea and ataxia 
MS 
somatization

Question 5

Investigations and risk scoring

Answer 5

FBC, ESR, UEC, BGL, Lipids
CXR, Carotid USS +/- angiography, CT or diffusion MRI, ECHO (?patent foramen ovale)
ECG

ABCD2
Age > 60
BP >140/90
Clinical features - unilateral weakness (2)
- speech disturbance (1)
Duration of Sx - > 1h (2) or 10-59min (1)
Diabetes

0-3 = 1% 7 day stroke risk = urgent TIA OP
4-5 = 6% = observation in stroke unit 
6-7 = 12% = observation in stroke unit

Question 6

Management

Answer 6

Education
- no driving for 1/12
Lifestyle
- diet, exercise
- smoking cessation
Medical
- control CV risk = BP, statin, DM, smoking
- Antiplatelet = aspirin +/- clopidogrel
- Anticoagulant = if cardiac embolic (eg AF or Mi Sten)
Surgical
- carotid endartectomy if > 70% stenosed and operative risk is good (50-70% if really good operable otherwise)
- anything done need to be within 2 weeks
- Don’t use antiplatelets before
- Carotid stenting is good alternative