TIA

Question 1

definition of transient ischaemic attack

Answer 1

transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

Question 2

assessment of patients with acute focal neurological symptoms that resolve completely within 24 hours of onset (i.e. suspected TIA)

Answer 2

give aspirin 300mg immediately unless contraindicated

• assessed urgently within 24hrs

Question 3

TIA mimics

Answer 3

hypoglycaemia

intracranial haemorrhage
- all on anticoagulants or similar RF should be admitted for urgent imaging to exclude haemorrhage

Question 4

mx of TIA patient who presents more than 7 days since sx onset

Answer 4

see stroke specialist ASAP + within 7days

Question 5

imaging in TIA

Answer 5

CT not routinely done - only if suspicion of alternative diagnosis

MRI (including diffusion-weighted + blood-sensitive sequences)
- preferred to determine the territory of ischaemia or detect haemorrhage

–> should be done same day as assessment

Question 6

management for patients within 24 hours of onset of TIA or minor ischaemic stroke and with a low risk of bleeding

Answer 6

clopidogrel + aspirin
- both, an initial dose of 300mg then75mg

for 21 days

Question 7

long term secondary prevention after TIA

Answer 7

clopidogrel

(after 21 days since TIA)

Question 8

medical management of TIA if patient not suitable for DAPT

Answer 8

clopidogrel 300mg loading dose followed by 75mg od

Question 9

what other drug should be considered when prescribing DAPT

Answer 9

PPI

Question 10

critera for carotid endartectomy

Answer 10

stenosis >50% according to NASCET criteria

also patient CANT be severly disabled from prev stroke/tia

–> must be performed ASAP + within 7days

Question 11

imaging for carotid artery post TIA

Answer 11

carotid duplex US

or CT angiography or MR angiography