TIA

Question 1

What offer to someone with suspected TIA?

Answer 1

Offer aspirin 300mg immediately unless contraindicated

Question 2

What is first line investigation for TIA?

Answer 2

CT to exclude haemorrhage

Question 3

What is a TIA?

Answer 3

Transient - less than 24 hours - neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without evidence of acute infarction. Most resolve within one hour

Question 4

Intracerebral bleed vs subarrach causes

Answer 4

IC bleeds occur due to diseases affecting small cerebral vessels eg HPTN
SAH - aneurysms, AV malformations, dissections, anticoags etc

Question 5

Conditions risk factors for stroke

Answer 5

Migraine
Hyperlipidaemia.
Diabetes mellitus.
Sickle cell disease.
Haemophilia.
Antiphospholipid syndrome and other hypercoagulable disorders.
Chronic kidney disease.
Ehlers-Danlos syndrome.
Marfan syndrome.
Pseudoxanthoma elasticum.
Polycystic kidney disease.
Neurofibromatosis type I.
Obstructive sleep apnoea
Vascular malformations
Peripheral vascular disease
Establisjed cardiovascular disease

Question 6

Early complications of stroke

Answer 6

HAEMORRHAGIC TRANSOFRMATION
Cerebral oedema
Delirium
Seizures
Venous throboembolism -> PE
Cardiac complications - MI, HF, AF, arrhythmias
Infection

Question 7

Mobility problems after stroke

Answer 7

Hemiparesis or plegia
Atacia
Falls
Spasticity and contractures
Loss/altered sensation

Question 8

Why pain after stroke long term?

Answer 8

MSK - abnormal positioning etc
Neuropathic

Question 9

Cognitive problems after stroke

Answer 9

Dyspraxia
Impaired attention and concentration
Impaired executive function
Spatial awarenedd eg left sided neglect, hemianopia

Question 10

Visual problems after stroke

Answer 10

Altered acuity, hemianopia, diplopia, nysstagmus, blurred

Question 10

Visual problems after stroke

Answer 10

Altered acuity, hemianopia, diplopia, nysstagmus, blurred

Question 11

Communication problems after

Question 12

Causes of TIA

Answer 12

Thrombus formation eg AF
Atherosclerosis
Shock
Vasculitis

Question 13

PresenationTIA

Answer 13

Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss

Question 14

FAST tool

Answer 14

Face
Arm
Speec
Time - act fast 999

Question 15

ROSIER tool when is stroke likely

Answer 15

If score above 0

Question 16

Secondary prevention of stroke medication(long term managemtent)

Answer 16

Clopidogrel 75mg oncec daily
Atorvastatin 70mg
Carotid endarectomy or stent if CAD
Treat modifiable risk factors

Question 17

Causes of TIA

Answer 17

embolic, thrombotic, haemorrhagic
Carotid bifurcation

Question 18

Long term prevention of TIA

Answer 18

HPTN, DM, obesity, smoking - decerase risk factors/treat

Question 19

Investigations TIA

Answer 19

BLoods
ECG/ambulatory ECG
CT brain
MRI brain
Carotid imaging eg doppler and duplex, CTPA
Transoesophageal ECHO

Question 20

What bloods do in TIA

Answer 20

FBC, ESR/CRP, U+Es, LFTs, TFTs, glucose cholesterol, clotting factors and antiphospholipid antibodies

Question 21

What are CT brain and MRI used for?m

Answer 21

Rule out haemorrhage
MRI - region of ischaemia

Question 22

Why do carotid imaging in TIA

Answer 22

Check for atheroma and stenosis

Question 23

ECHO in TIA for what

Answer 23

Rule out transmural thrombus, valvular HD

Question 24

How long cant drive after a TIA vs multiple

Answer 24

1 month Multiple over short period - 3 months + notify DVLA

Question 25

What are the features of carotid territory symptoms?

Answer 25

Amourosis fugax Aphasia Hemiparesis Hemisensory loss Hemianopic visual loss

Question 26

Features of vertobrobasilar territory symptoms

Answer 26

Diplopi a Vertigo Vommitting Choking and dysarthria Ataxia Hemisensory loss Hemianopic or bilateral visual loss Tetraparesis LOC

Question 26

Features of vertobrobasilar territory symptoms

Answer 26

Diplopi a Vertigo Vommitting Choking and dysarthria Ataxia Hemisensory loss Hemianopic or bilateral visual loss Tetraparesis LOC

Question 27

Differentials for TIA

Answer 27

Stroke Hypoglycaemia Migraine with aura Focal epilepsy Intracranial lesion eg tumour or haemorrhage Hyperventialtion Retinal or vitreous haemorrhage Labyrinth disorder Maliganant HPTN

Question 28

Score for deciding TIA managment

Answer 28

ABCD2 score

Question 29

ABCD2 score

Answer 29

Age over 60 BP over 140/90 Clinical featires - unilateral weakness, speech disturbance Duration symptoms - over 60 mins = 2, 10-59 imns = 1 Diabetes w

Question 30

What is low risk and high risk on ABCD2

Answer 30

1-3 = low 6-7 = high

Question 31

Absolute contraindications for thrombolysis in stroke

Answer 31

Prev intracrnaial haemorrhage Seizure at onset of stroke Intracranial neoplasm Sus SAH Stroke/traumatic head injury prev 3 months LP in last week GI haemorrhage last 3 weeks Active bleed Pregnancy Oesophageal varices Uncontrolled HPTN >200/120

Question 32

Relative contraindications for thrombolysis stoke

Answer 32

Concurrent anticoagulation - INR >1.7 Haemorrhegic diathesis Active diabetic haemorrhagic retinopathy Sus intracardiac thrommbus Major surgery or trauma in last 2 weeks

Question 32

Relative contraindications for thrombolysis stoke

Answer 32

Concurrent anticoagulation - INR >1.7 Haemorrhegic diathesis Active diabetic haemorrhagic retinopathy Sus intracardiac thrommbus Major surgery or trauma in last 2 weeks