Transient Ischaemic Attack 'TIA'

Also known as a mini stroke it is caused by a temporary cut off of blood to the brain
FAST & ROSIER
People who have had a TIA often do not present with neurological symptoms at the time of assesment
1. These people should be assessed for thier subsequent risk of stroke
  1. The ABCD2 system is used which is optimized to predict the occurance of stroke within 2days but can predict up to 90days
    1. It uses 5 independent factors and adds up the scores to calculate risk
    2. Factors assessed include:
      1. Age >60
      2. High Blood pressure
      3. Unilateral weakness with or without speech impairment
      4. Speech impairment without unilateral weakness
      5. TIA lasting >60mins
      6. TIA between 10-59mins
      7. Diabetes
  2. People with a ABCD2 score of 4 or above are high risk
    1. Asprin daily
    2. Investigation within 24 hours
      1. Urgent brain imaging
        DWI MRI *
        CT to exclude extracerebral haemorrhage & tumour
    3. Measures for secondary prevention introduced as soon as diagnosis is confirmed
People with two or more TIA's in a week
1. Should be treated as high risk even if ABCD2 score may be less than 3
People who have suspected TIA but are low risk (ABCD2 less than 3)
1. Aspirin daily
2. Specialist assesment within 1 week
  1. Brain imaging
    1. DWI MRI
3. Measures for secondaray prevention introduced and discussion of risk factors
People who have had a TIA or stroke may have narrowing of the carotid artery
1. Those considered as candidates for carotid endarterectomy
  1. Carotid imaging within 1 week unless last symptom was more than 1 week prior
    1. Those who have 50-99% carotid stenosis according to NASCET(North American Symptomatic Carotid Endarterectomy Trail) or 70-99% according to ECST (European Carotid Surgery Trailists Collaborative Group)
      1. Assesed and reffered for carotid endarterectomy within 1 week
      2. Undergo surgery within 2 weeks
      3. Receive
        Blood pressure drugs
        Cholesterol lowering drugs & diet
        Lifestyle advice
    2. Those who have less than 50% carotid stenosis according to NASCET or less than 70% according to ECST
      1. Not undergo surgery
      2. Blood pressure drugs
      3. Cholesterol lowering drugs and diet
      4. Lifestyle advice
Cartotid Artery Imaging
1. US
  1. Linear shows bifurcation - most common site of disease
  2. Spectral doppler
    1. Velocity inofrmation
    2. Higher velocity = higher degree of stenosis
    3. Degree of stenosis calulated from readings
2. MRA
3. CTA
Cardiac Imaging
1. Should be performed for those with normal brain scans to identify the central source of emboli

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Transient Ischaemic Attack 'TIA'

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	Created by heather.dobson.b almost 11 years ago