Transient Ischaemic Attack / TIA

• What is a Transient Ischaemic Attack (TIA) commonly known as?


  Mini-stroke
• What characterizes a Transient Ischaemic Attack (TIA)?


  It is characterized by a sudden focal neurological deficit with symptom resolution typically within an hour.
• How does a TIA differ from a stroke in terms of imaging?


  A TIA shows no acute infarct on imaging, while a stroke does.
• What are key signs and symptoms of a TIA?


  Speech difficulty, arm/leg weakness, and sensory changes.
• What are important differential diagnoses to consider for a TIA?


  Focal seizures, migraine, and intracranial bleeding.
• What investigations are primarily involved in diagnosing a TIA?


  Neuroimaging.
• What is the main goal of management for a TIA?


  To reduce future stroke risk.
• What do NICE guidelines recommend for individuals with suspected TIA?


  Immediate referral for assessment within 24 hours.
• What is the definition of a TIA?


  A sudden-onset focal neurological deficit with a vascular aetiology, typically resolving within less than 1 hour.
• What is the incidence of TIA cases per 100,000 person-years?


  230 cases per 100,000 person-years.
• What are the risk factors for TIA?


  • Hypertension
  • Diabetes mellitus
  • High cholesterol
  • Atrial fibrillation
  • Carotid stenosis
  • Smoking
  • Family history of cardiovascular disease/stroke
  • History of cardio-embolic events
• What symptoms may patients present with during a TIA?


  Sudden onset of focal neurological deficits including speech difficulty, arm or leg weakness, sensory changes, ataxia, vertigo, loss of balance, and visual disturbances.
• What visual disturbances can occur during a TIA?


  Homonymous hemianopia and diplopia.
• What are the differential diagnoses for TIA?


  • Stroke: Persistent symptoms with evidence of ischaemia on MRI imaging
  • Focal motor seizures: Positive symptoms preceding weakness
  • Migraine with aura: Preceding aura with visual disturbances, tingling, or numbness, followed by headache
• What investigations are recommended for TIA diagnosis?


  • Neuroimaging (preferably MRI)
  • Carotid ultrasound (for carotid stenosis)
  • Echocardiogram (for cardiac thrombous)
  • 24-hour tape (for atrial fibrillation)
  • Blood tests (glucose, lipid profile, clotting factors)
• What is the recommended timeframe for assessment after a suspected TIA?


  Ideally within 24 hours of onset of symptoms.
• What are the management strategies for TIA?


  • Lifestyle modifications (smoking cessation, regular exercise, healthy diet)
  • Control of vascular risk factors (hypertension, diabetes, dyslipidaemia)
  • Initiation of antiplatelet therapy (e.g., aspirin, clopidogrel)
  • Possible endarterectomy or stenting of the carotid artery based on stenosis criteria
• What percentage of carotid stenosis is indicated for endarterectomy according to ECST criteria?


  70% stenosis.
• What percentage of carotid stenosis is indicated for endarterectomy according to NASCT criteria?

  50% stenosis.