TIA

Question 1

What is a TIA?

Answer 1

An ischaemic (usually embolic) neurological event with symptoms lasting <24 hours, typically less than 1 hour.

Question 2

What are the causes of a TIA?

Answer 2

1. Atherothromboembolism from the carotids are the main cause
2. Cardioembolism - mural thrombus post MI, AF, valve disease
3. Hyperviscosity - polycythaemia, sickle cell, myeloma

Question 3

What signs are typically present in a TIA?

Answer 3

1. Specific to artery territory
2. Amaurosis fugax when retinal artery occluded - unilateral progressive vision loss
3. Global events (syncope, dizziness) are NOT typical.

Question 4

What is the Roiser scoring system for?

Answer 4

Differentiation between stroke and other stroke mimics in A&E. Over zero means a stroke is likely.

Question 5

What imaging is done for someone with a suspected TIA?

Answer 5

1. Carotid doppler, angiography
2. CT
3. Echocardiogram

Question 6

What is the ABCD^2 score, what does it stand for, and what is the investigation recommended for the scores?

Answer 6

1. Stratifies patient at higher risk of having a stroke after a suspected TIA.
2. Age >60 (1), BP >140/90 (1), clinical features (weakness 2, speech disturbance 1, other 0), duration of symptoms (0-2), diabetes history (1).
3. 4 or more is high risk, specialist assessment and CT <24 hours. Less than 4, CT within 1 week.

Question 7

What is the treatment for a suspected TIA?

Answer 7

1. Control BP, DM, smoking, hyperlipidaemia
2. Aspirin 300mg for 2 weeks then clopidogrel monotherapy 75mg OD
3. If heart, then anticoagulate with DOAC/warfarin

Question 8

What do the DVLA advise for driving after a suspected TIA?

Answer 8

Not for 1 month, no need to inform DVLA.