Transient Ischemic Attack Flashcards Preview

724: Medical Lectures > Transient Ischemic Attack > Flashcards

Flashcards in Transient Ischemic Attack Deck (38)
1

What are Transient ischemic attacks characterized by?

focal ischemic cerebral neurologic deficits that last for < 24 hours

2

How long does a TIA usually last?

less than 1-2 hours

3

__% of patients with stroke have a history of transient ischemic attacks

30%

4

What is an important cause of TIA?

embolization

5

What 2 locations are emboli apparent?

- heart
- extracranial arteries

6

What are the cardiac causes of embolic ischemic attacks?

- atrial fibrillation
- rheumatic heart disease
- mitral valve disease
- infective endocarditis
- atrial myxoma
- mural thrombi complicating myocardial infarction

7

What are paradoxical emboli?

Emboli that travel from the veins to the brain through atrial septal defects and patent foramen ovale

8

An ____ plaque on a major artery to the brain may also serve as a source of emboli

ulcerated

9

Where is atherosclerosis most commonly seen? What does this cause?

in the Carotid bifurcation extracranially

causes a bruit

10

Patients with what disease have an increased risk of developing transient ischemic deficits or strokes?

AIDS

11

What are 4 other less common abnormalities of blood vessels that may cause a TIA?

- Fibromuscular dysplasia
- atherosclerosis of the aortic arch
- inflammatory arterial disorders such as giant cell arteritis, SLE, polyarteritis, and granulomatous angiitis
- Meningovascular syphilis

12

Although hypotension may cause a reduction of cerebral artery blood flow if a major extracranially artery to the brain is stenosed, this is a ____ source of TIA

rare

13

Other than what has already been listed, list 4 other disorders that can cause a TIA

- polycythemia
- sickle cell disease
- hyperviscosity syndromes
- severe anemia

14

Subclavian ____ syndrome may lead to transient vertebrobasilar ischemia.

steal

15

When do symptoms of subclavian steal syndrome arise?

When there is localized stenosis or occlusion of one subclavian artery proximal to the source of the vertebral artery, so that blood is "stolen" from it.

16

What are the signs and symptoms of subclavian steal syndrome?

- bruit in the supraclavicular fossa
- unequal radial pulses
- difference of 20 mm Hg or more between the systolic blood pressures in the arms

17

What do specific symptoms of a TIA depend on?

the arterial distribution affected

18

The risk of stroke is high in the first _ months after an attack, particularly in the _ month and especially within the first __ hours

3

first

48

19

There is a higher risk for stroke with what type of attack?

carotid ischemic attacks

20

Stroke risk is greatest in patients __ years of older and those who have ______.

60

diabetes

21

Stroke risk is greatest after transient ischemic attacks that last longer than __ minutes and with symptoms or signs of weakness, speech impairment, or gait disturbance.

10

22

What imaging technique is indicated within the first 24 hours of symptom onset?

CT and MRI

23

What type of MRI is particularly sensitive for revealing acute or subacute infarction?

MRI with diffusion-weighted sequences

24

What imaging technique is especially useful for detecting significant stenosis of the internal carotid artery?

carotid duplex ultrasonography

25

What does an invasive cerebral arteriography allow for?

angioplasty or other interventions if necessary

26

____ monitoring is indicated id a transient, paroxysmal disturbance of cardiac rhythm is suspected

Holter

27

What are the 3 differential diagnoses of TIA?

- Focal seizures
- Classic migraine
- Focal neurological deficits due to hypoglycemia

28

What is a commonly used method to assess recurrence risk?

ABCD2 score

29

An ABCD2 score of _ or more points has been suggested as a threshold for hospital admission.

3

30

What is medical treatment aimed at?

preventing further attacks and stroke

31

When treating causes such as diabetes mellitus, hematologic disorders, and hypertension what medication is typically preferred?

an angiotensin-­converting enzyme inhibitor or angiotensin receptor blocker

32

What other drug should also consider being started?

statins

33

What are 3 lifestyle changes that patients should adopt?

- Smoking cessation
- Weight reduction
- Regular physical activity

34

When is cardioembolism from the heart an indication for anticoagulation as a preventive treatment for stroke?

When is in the setting of atrial fibrillation

35

What drugs are indicated for the treatment of embolism from the heart?

anticoagulants

36

List the 4 drugs prescribed in noncardiacembolic attacks

- Low-dose aspirin (81 mg)
- Dipyridamole
- Clopidegrol
- Cilostazol

37

When are surgical or endovascular measures indicated?

When arteriography reveals a surgically accessible high grade stenosis (70-99% in luminal diameter)

38

Surgical or endovascular measures have moderate benefit is patients with __-__% stenosis and no benefit in mild stenosis less than __%

50-69

50