TIA

Question 1

Definition of TIA?

Answer 1

• Sudden onset focal neurology lasting <24h due to temporary occlusion of part of the cerebral circulation.
• ~15% of 1st strokes are preceded by TIAs.

Question 2

Causes of TIA?

Answer 2

I. Atherothromboembolism from carotids (MAINLY)
II. Cardioembolism: post-MI, AF, valve disease
III. Hyperviscosity: polycythaemia, SCD, myeloma

Question 3

Investigations for TIA?

Answer 3

• Aim to find cause and define vascular risk
  I. Bloods: FBC, U&E, ESR glucose, lipids
  II. CXR
  III. ECG
  IV. Echo
  V. Carotid doppler ± angiography
  VI. Consider Diffusion weighted MRI

Question 4

Timing of management of TIA and risk of another stroke?

Answer 4

• Intervention w/i 72hrs → 2% strokes @ 90d

- Intervention w/i 3wks → 10% strokes @ 90d

Question 5

Management of TIA?

Answer 5

ACAS

1. Antiplatelet/coagulate:
   - aspirin/clop 300mg/d for 2 wks, then 75mg/d
   - or warfarin if AF, MI
2. Cadiac RFs control
3. Assess risk of future stroke (ABCD2 score)
4. specialist referral
   - ABCD2 ≥4: w/i 24hrs
   - ABCD2 <4: w/i 1wk

Question 6

Prognosis for TIA patients?

Answer 6

3x ↑ in mortality cf TIA-free populations

Question 7

ABCD2 score components

Answer 7

Predicts stroke risk following TIA
1. Age≥60
2. BP ≥ 140/90
3. Clinical features
a. Unilateral weakness (2 points)
b. Speech disturbance w/o weakness
4. Duration
a. ≥ 1h (2 points)
b. 10-59min
5. DM
Max score: 7

Question 8

What is ABCD2 score used for?

Answer 8

• Predicts stroke risk following TIA

- Score ≥6 = 8% risk w/i 2d, 35% risk w/i 1wk