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TIA Flashcards

1
Q

What is a TIA

A

Temporary focal cerebral ischaemia which presents suddenly with brief neurological deficit

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2
Q

How long do TIAs last

A

5-10 mins attack
<24 hours without infarction

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3
Q

What are the risk factors for TIA

A 
Age
HTN/smoking and diabetes
Hyperlipidaemia
AF
Clotting disorders
Combine OC pill
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4
Q

What are the causes of TIA

A 
Atherothromboembolism
-Carotid artery (hear a carotid bruit)

Cardioembolism
-AF
-Post MI
-Valve disease
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5
Q

What are the Carotid presentations of TIA (90%)

A 
Amourosis Fugax
Aphasia (can't communicate)
Hemiparesis (Cant move one side)
Hemisensory loss (Can't feel one side)
Hemianopic vision loss
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6
Q

What are the Vertebrobasilar presentations of TIA (10%)

A 
Vertigo
Choking and vomiting
Ataxia
Hemisensory loss
Hemianopic vision loss
Tetraparesis (4 limb weakness)
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7
Q

What is Amourosis fugax

A

Unilateral sudden vision loss caused by Retinal artery occlusion

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8
Q

How would you investigate a TIA

A 
FAST (Public health scheme)
ABCD2
Brain Imaging
Carotid Imaging (Doppler US/Angiography)
ECG
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9
Q

What blood tests would you do for a TIA

A

Glucose
FBC = Polycythaemia
ESR = Raised in vaculitis
INR = If on Warfarin

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10
Q

What is the ABCD2 score used for after TIA

A 
To check risk of Stroke
A-age >60
B-BP >140/90
C- Check symptoms 
D- Duration of symptoms
D- Diabetes
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11
Q

How would you manage a TIA

A 
300mg Aspirin
Prophylaxis Therapy
-Clopidogrel w/ Atorvastatin
Anticoagulation for AF
Carotid Endarterectomy
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12
Q

When would you do Carotid endarterectomy

A

If stenosis greater than 70%

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13
Q

What are the Focal neurological deficits of TIA

A

ACA = Contralateral leg numb and weak
MCA = Contralateral body weak and numb, forehead spared face droop and dysphagia
Amaourosis Fugax
PCA = Vision loss (Macular sparing contralateral hamonymous hemianopia)
Vertebral = Cerebellar syndrome, brainstem infarct and CN Lesions 3-12

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14
Q

What is a sign of the TIA affecting ACA

A

Contralateral leg numbness and weak

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15
Q

What is a sign of a TIA affecting the MCA

A

Contralateral body weakness and numb
Forehead sparing face droop
Dysphagia

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16
Q

What is a sign of TIA affecting the PCA

A

Contralateral homnoymous hemianopia
(macular sparing)

-Macular sparing

17
Q

What are the signs of TIA affecting the vertebral artery

A

Cerebellar syndrome (Positive romberg)
Brainstem infarct
CN 3-12 Lesions

18
Q

What is cerebellar syndrome

A

Sensory and motor ataxia
Positive romberg

Dx with Positive Romberg test

19
Q

What are the 2 scoring systems used in TIA

A

FAST
ABCD2

ABCD2

20
Q

Acute management of TIA

A

Aspirin 300mg

21
Q

Prophylaxis of TIA

A

Clopidogrel 75mg and atorvastatin 80mg

22
Q

CN1 Lesion

A

Olfactory - unilateral anosmia

23
Q

CN2 Lesion

A

Optic- visual loss/field defects

24
Q

CN3 Lesion

A

Occulomotor - Ptosis (Loss of levateaur palpebrae function)

25
Q

CN4 Lesion

A

Trochlear - Diplopia with no down and out movement

26
Q

CN5 Lesion

A

Trigeminal - Facial anaesthesia and pain (episodic)

27
Q

CN6 Lesion

A

Abducens - Diplopia with no lateral movement

28
Q

CN7 Lesion

A

Facial - Hemifacial paralysis (LMN/UMN)/Bell’s Palsy

29
Q

CN8 Lesion

A

Vestibulocochlear - Deafness

30
Q

CN9 Lesion

A

Glossopharyngeal - Loss of palatal elevation

31
Q

Occlusion of what arteries can lead to amourosis fugax

A

Opthalmic and retinal arteries

32
Q

What three things shhould be considered before antithrombolytic therapy with aspirin

A
  1. Bleeding disorder and DOAC treatment
  2. Patient already on low dose aspirin
  3. Aspirin is contraindicated
33
Q

Should Brain CT be done for TIA

A

It should be avoided unless clinical exam suggests alternative diagnosis to TIA

34
Q

What is the recommended imaging used in TIA for ischaemia determination

A

MRI on same day of referral

35
Q

Atheroembolisms can play a role in TIA formation; what imaging should be offered to determine source

A

Urgent carotid doppler
(Carotid endaerterectomy)

36
Q

Antiplatelet therapy follows aspirin use in management as 2nd line; what should a patient contraindicated with clopidogrel be offered

A

Dipyradimole

37
Q

What is the aim of atorvastatin in TIA

A

Reduce LDL Cholesterol by more than 40%

38
Q

When should carotid endarterectomy be considered

A

carotid stenosis >70%

Neuro (27 decks)

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