Transient Ischaemic Attacks : Definition , Clinical Presentation , Causes and Management

 Transient Ischaemic Attacks :

TIA are defined as episodes of transient focal neurological  deficit lasting for less than 24 hours.

They often precede  strokes ( the risk of subsequent cerebral infarction is 5 % within 1 year.

TIAs are the cerebrovascular equivalent of Unstable Angina.

Clinical presentation:

Carotid artery involvement produces : 

Unilateral changes and sensory changes.

Dysphasia

Homonymoun Hemianopia

Amaurosis fugax

Vetebro basilar artery territory produces :

Blackouts

Vertigo

Ataxia

Bilateral motor or sensory changes

Causes :

Usually the TIAs result from thromboembolic diseases involving the heart (Atrial fibrillation , mitral stenosis , artificial valves or post MI ) or extracranial vessels ( Carotid artery stenosis ).

Hypertension

Polycythemia

Anemia

Vasculitis ( Temporal arteritis , PAN/ Polysrteritis nodosa SLE )

Hypoglycemia

Syphilis

An episode of  hypoperfusion

Investigations :

Check BM levels / blood glucose

Send blood for FBC , ESR , U &Es  and Blood Glucose levels.

An ECG to look for arrhythmias or heart block  and a  Chest X ray should be done . 

Management :

After the above investigations have been performed, if they show a positive finding, appropriate referral should be  done to the relevant teams.

If a patient has residual neurological deficit , they should be kept in hospital and managed after further investigations eg CT head or MRI brain.

All patients who have made a complete recovery and don’t have any evidence of residual neurological deficit should be discharged.