TIA

• A transient ischaemic attack is a sudden onset focal neurological deficit of vascular origin, lasting less than 24 hours

  A TIA is typically caused by an embolism

  AF and carotid stenosis are the most important causes to identify
• Symptoms of a TIA depends of the arterial territory involved but are characterised by a sudden onset and short duration
• Investigations for a TIA:

  • Urgent referral to be seen by stroke specialist within 24 hours
  • ECG - to identify AF
  • Carotid ultrasound - to identify carotid plaque or stenosis
  • Diffusion weighted MRI
• Management of fully resolved TIA:

  • 300mg of aspirin immediately and refer for urgent stroke specialist assessment
  • Screen for AF and carotid stenosis
  • Carotid endarterectomy if 70-99% stenosis
  • If patient not at high risk of bleeding - aspirin and clopidogrel 75mg for 21 days
  • Secondary prevention - life style advice and a statin
• Symptoms of TIA:

  • Weakness - temporary weakness or paralysis, often unilateral
  • Numbness or tingling
  • Dysarthria or aphasia
  • Transient vision disturbances - less of vision, diplopia and amaurosis fugax (loss of vision in one eye)
  • Dizziness or loss of balance
  • Headache
• Differentials:

  • Hypoglycaemia
  • Migraine aura
  • Seizure
  • Syncope
• Lab investigations:

  • FBC
  • Blood glucose levels - identify diabetes
  • Lipid profile
  • Coagulation screen
  • ESR to exclude GCA in ocular TIA or patients with a headache
• Risk factors:

  • More common in adults over 55
  • Men at slightly higher risk
  • Smoking
  • Hypertension
  • AF
  • Diabetes
  • Family history of stroke or TIA
  • Prior TIA or stroke
  • Vasculitis
• Unresolved acute neurological deficits present <24 hours should be treated as acute stroke and referred urgently for acute stroke service assessment.
• • If TIA is confirmed and not at high risk for haemorrhage, dual antiplatelets for 21 days: i.e., continue aspirin at 75mg daily and load additionally with clopidogrel 300mg stat, then 75mg daily
• • Initiate secondary prevention: lifestyle advice, statin, smoking cessation, hypertension and diabetes management