TIA

Question 1

symptoms of a TIA

Answer 1

The person presents with sudden onset, focal neurological deficit which has completely resolved within 24 hours of onset and cannot be explained by another condition such as hypoglycaemia. Most TIAs are thought to resolve within 1 or 2 hours but can persist for up to 24 hours. Focal neurological deficits may include:

• Unilateral weakness or sensory loss.
• Dysphasia.
• Ataxia, vertigo, or incoordination.
• Syncope.
• Sudden transient loss of vision in one eye (amaurosis fugax).
• Homonymous hemianopia.
• Cranial nerve defects.

Question 2

Mx for TIA

Answer 2

conservative

• lose weight if obese
• stop smoking and drinking alcohol
• increase activity levels

medical
Immediate antithrombotic therapy:
give aspirin 300 mg immediately, unless contraindicated refer for specialist review within 24 hrs

antithrombotic therapy

• clopidegrol first line
• aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel

Question 3

when might aspirin be contradicted in a pt

Answer 3

the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)

Question 4

If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:

Answer 4

discuss the need for admission or observation urgently with a stroke specialist

Question 5

If the patient has had a suspected TIA in the last 7 days:

Answer 5

arrange urgent assessment (within 24 hours) by a specialist stroke physician

Question 6

If the patient has had a suspected TIA which occurred more than a week previously:

Answer 6

refer for specialist assessment as soon as possible within 7 days

Question 7

DDx of TIA

Answer 7

hypoglycaemia episode
social anxiety
postural hypotension

Question 8

RFs of TIA

Answer 8

smoling
diabetes
HTN
age
previous dyslipisaemia
IHD
heart valve abnormalities
coagulopathy
OCP
FH

Question 9

Ix for TIA

Answer 9

• ECG -> AF/MI
• carotid artery doppler US
• FBC- polycythaemia
  ESR - raised in endocarditis and vasculitis
  U&Es
• CT/MRI
• echocardiogram
• fasting blood lipids and cholestrol
  glucose
  autoantibody profile