Transient Ischaemic Attack (TIA)

A TIA is where there's sudden onset focal neurological deficit of vascular aetiology, with symptoms lasting < 24 hrs (usually < 1 hr) and no evidence of acute infarct on imaging. This increases the risk of a full stroke, so secondary prevention is necessary.

Causes:

• Carotid embolism

• Cardioembolism - AF or Mural thrombus post-MI

• Hyperviscocity - Polycythaemia, Sickle cell

Presentation

• Focal neurological deficit - e.g. dysphasia, limb weakness, sensory loss

• Absence of positive symptoms suggestive of differentials e.g. shaking preceding the weakness

• Absence of headache, which suggests migraine or intracranial bleeding

Investigations

• Glucose

• ECG

• Bloods - FBC, U&Es, CRP, Clotting

Management

• Immediate Aspirin 300mg for 14 days

• Switch to Clopidogrel 75mg for long-term prevention

• Atorvastatin 20-80mg

• Optimise control of other risk-factors