Table Of Contents
Transient Ischemic Attack
A transient ischaemic attack (TIA) is defined as neurological deficits that completely resolve within 24 hours. 80% of TIAs are due to thromboemboli and they occur almost exclusively in patients with symptomatic large vessel disease e.g. carotid artery stenosis.
A transient event is more likely to be vascular if the patient has a high ABCD2 score. Patients with a score of ≥ 4 are admitted to hospital for investigation within 24 hours
Features of a Transient Ischemic Attack (ABCD2 score)
| Component | Points |
|---|---|
| Age ≥ 60 years | 1 |
| Blood pressure ≥ 140/90 mmHg | 1 |
| Clinical features: a) unilateral weakness, b) speech disturbance with no weakness | a) 2, b) 1 |
| Duration of symptoms a) 10 – 60 minutes, b) > 60 minutes | a)1, b) 2 |
| History of Diabetes | 1 |
This gives a total score ranging from 0 – 7. Patients with a suspected TIA and are at a higher risk of stroke have an ABCD2 score of ≥ 4.
A crescendo TIA (2 or more episodes in a week) is treated as being a high-risk of stroke even with an ABCD2 score of < 4.
- Causes of TIA
- Atherothromboembolism
- Cardioembolism (from mural thrombus)
- Post-MI
- Atrial fibrillation
- Valve disease
- Prosthetic valve
- Hyperviscosity
- Polycythaemia
- Sickle-cell anaemia
- Myeloma
- Vasculitis
- Cranial arteritis
- Polyarteritis nodosa
- SLE
- Syphilis
- Physical examination
- Carotid bruit
- High blood pressure
- Radial/radial delay and difference in brachial pressure > 200 mmHg suggest subclavian artery stenosis
- Differentials
- Hypoglycaemia
- Focal epilepsy with Todd’s paralysis
- Migraine
- Malignant hypertension
- Multiple sclerosis 9paroxysmal dysarthria)
- Intracranial tumors
- Peripheral neuropathy
- Phaechromocytoma
- Somatization
- Investigations
- Electrocardiogram
- Echocardiogram
- Carotid doppler +/- angiography
- Blood glucose
- Complete blood count
- UECs
- Lipid panel
- Non-contrast CT scan or DWI MRI
- Treatment
- Optimize cardiovascular risk factors
- Aspirin or clopidogrel 300 mg STAT
- Anticoagulation if indicated
- Carotid edarterectomy if indicated
- Suffered stroke or TIA in the carotid territory and is not severely disabled
- Carotid stenosis > 70% (ECST criteria) or 50% (NSCET criteria)
- Prohibit driving for at least 1 month
