5

• Transient Ischemic Attack (TIA)


  Focal neurological deficit usually lasting <1 h, resolving completely within 24 H
• TIA


  • Focal brain, spinal cord, retinal ischemia (amaurosis fugax) without infarction (normal imaging)
  • May present as visual field cuts, dysarthria, double vision, vertigo, numbness, weakness, focal sensory/motor disturbances
• ABCD2 score for risk of stroke after TIA


  1. Age > or = 60 (1)

  2. BP > or = 140 systolic or 90 diastolic (1)

  3. Unilateral weakness (2)

  4. Speech disturbance without weakness (1)

  5. Duration > or = 60 min (2)

  6. Duration 10-59 min (1)

  7. Duration < 10 min

  8. DM (1)
• Imaging for TIA


  1. MRI within 24 h if ABCD2 score > or = 4 or Crescendo TIAs (> or = 2/week)

  2. If lower risk à imaging within a week
• Investigating cause of TIA


  1. ECG + Holter

  2. Echo (thrombus or vegetations)

  3. Carotid US: may show carotid dissection or carotid artery stenosis
• Carotid artery stenosis


  • Stenosis > 70% & symptoms à endartectomy
  • Stenosis < 50% à no intervention
  • Stenosis 100% à no intervention
• Chronic treatment of TIA

  Aspirin, statin, risk factor control
• Aphasia types


  • Fluent, Comprehension, Repeats: Anomic
  • Fluent, No Comprehension, Repeats: Wernicke's/sensory
  • Fluent, No Comprehension, No Repeats: Conduction
  • Non-fluent, Yes Comprehension, Yes Repeats: Transcortical motor
  • Non-fluent, No Comprehension, Yes Repeats: Broca's/motor
  • Non-fluent, No Comprehension, No Repeats: Global
• Broca's Aphasia (Motor)


  Slow, laborious, non-fluent, poorly articulated speech (in both spontaneous speech and repetition) with spared word comprehension (can understand)
• Broca's Aphasia (Motor)


  • Ischemia or other lesions in the left posterior inferior frontal cortex, in the distribution of the superior division of the left middle cerebral artery (MCA)
• Wernicke's aphasia


  Fluent but meaningless speech output and repetition, with poor word and sentence comprehension
• Wernicke's aphasia does not strain to produce words and does not appear to be searching for them
• Wernicke's aphasia


  • Ischemia in the posterior superior temporal cortex, in the distribution of the inferior division of the left MCA
• Global aphasia


  Severe impairment in all aspects of language; the area of ischemia often involves both anterior and posterior language areas (Broca and Wernicke areas)