Transient ischaemic attack (TIA):
episode(s) of focal neurological disturbance of less than 24hrs due to vascular/ischaemic cause; significant prognostic risk factor for myocardial infarction and CVA
sudden onset and brief duration (usually 2 – 30 minutes); 50% last < 5mins
most due to small cerebral microemboli from atherosclerotic plaque – usually affects the internal carotid-middle cerebral or vertebrobasilar arteries
similar symptoms to stroke, but are transient
focal neurological deficits include – weakness or clumsiness of one side of the body; simultaneous bilateral weakness; dysphagia; ataxia; speech and language disturbances; sensory disturbances on one side of body; visual problems (loss of vision in one eye; diplopia; blindness); vertigo; amnesia
loss of consciousness is very unusual
neurological deficit is reversible – symptoms last <24 hours (unless have multiple infarcts)
24hr is the ‘epidemiological’ cut off in the definition between a TIA and stroke that is widely used clinically (distinction may be artificial)
diagnosis is clinical – not based on any specific test
indicative of cerebrovascular disease may be warning sign of CVA (major risk factor)
may have a ‘drop attack’ fall; may be due to vertebrobasilar ischaemia
differential diagnosis – seizure, migraine, tumour, subdural haematoma
management – address risk factors; antiplatelet drugs, anticoagulants
use of aspirin reduces risk of ischaemic stroke
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