Transient Ischaemic Attack

Question 1

what is a transient ischaemic attack

Answer 1

sudden onset focal neurological deficit of vascular aetiology, with symptoms typically lasting less than 1 hour, and no evidence of acute infarct on imaging

Question 2

some risk factors for transient ischaemic attacks

Answer 2

diabetes mellitus, high cholesterol, smoking, family Hx, CVD, atrial fibrillation

Question 3

why can atrial fibrillation increase the risk of TIA

Answer 3

it increases the risk for cardio-embolic events

Question 4

aetiology of TIA

Answer 4

It is usually EMBOLIC but may be thrombotic
Most common source of emboli = CAROTID atherosclerosis

Emboli can also arise from the heart:
Atrial fibrillation
Mitral valve disease
Atrial myxoma

Question 5

presenting symptoms of transient ischaemic attack;

Answer 5

Patients present with focal neurological deficit (such as speech difficulty or arm/leg weakness/sensory changes).

By definition a TIA is transient and most symptoms resolve within 1 hour.

There should be an absence of positive symptoms suggestive of differentials (e.g. shaking preceding the weakness, suggestive of a focal motor seizure).

There should be an absence of headache, which would suggest a differential e.g. migraine or intracranial bleeding.

Question 6

why will you auscultate the carotid arteries

Answer 6

for bruits, may be suggestive of carotid atherosclerosis

Question 7

management (FIRST LINE)

Answer 7

Patients with acute neurological symptoms that resolve completely within 24 hrs should be given 300 mg aspirin immediately and assessed urgently within 24 hrs

Question 8

management after administering aspirin

Answer 8

Clopidogrel - 300 mg loading dose and 75 mg thereafter

High-Intensity Statin Therapy - e.g. atorvastatin 20-80 mg

Question 9

how to prevent secondary TIA

Answer 9

Antiplatelets
Antihypertensives
Lipid-modifying treatments
Management of AF

Question 10

prognosis

Answer 10

very high risk of stroke in the first month after a TIA