QuestionSBA
QuestionChoice
The main priority is to initiate antiplatelet treatment with aspirin. The blood pressure is not dangerously high at this point and she does not have any serious concomitant medical issues requiring strict BP control (e.g. hypertensive encephalopathy, nephropathy or cardiac failure). In patients with a TIA who have recovered to their neurologic baseline and have no other evidence of infarction, anti-hypertensive treatment may be reinitiated
32085
c
Start amlodipine
QuestionChoice
While this patient does have a history of gastroesophageal reflux, the priority is to start her on an antiplatelet therapy (i.e. aspirin). She may require a H2 receptor antagonist such as ranitidine as an adjunct
32086
d
Start ranitidine
QuestionChoice
This is only recommended in acute ischaemic stroke within 4.5 hours of onset, where intracranial haemorrhage has been excluded on brain imaging. In this case, the patient has a transient ischaemic attack which would not warrant this
32084
b
Start alteplase
QuestionChoice
The patient has suffered a transient ischaemic attack (TIA) on a background of non-valvular atrial fibrillation (AF). In this case, as AF is likely the underlying cause of the TIA, anticoagulation (rivaroxaban) is superior to aspirin in stroke prevention. Therefore, aspirin would not be the best choice in this scenario.
32083
a
Start aspirin
QuestionChoice
NICE recommend commencing anticoagulant in secondary care for people with ischaemic stroke or TIA and paroxysmal, persistent, or permanent atrial fibrillation or atrial flutter. The choice of anticoagulant is a DOAC in non-valvular AF. 
32087
e
Start rivaroxaban
QuestionComment
How can the neuro exam be fine if he's had a stroke then?
6275
QuestionComment
TIA
7370
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Dermis Cystic
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Yellow Stasis
QuestionComment
ONLY after a CT scan has been done!!! this is wrong. he cannot be given aspirin until haemorrhagic ruled out
6567
QuestionComment
you don't CT for TIA
7369
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Dermis Cystic
QuestionComment
Yeah as above TIA can only be caused by a thrombus, a bleed cannot appear then disappear in the same way
22458
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Camiodarone
QuestionComment
So if someone comes in with a suspected TIA you will immediately give Aspirin 300mg + refer to TIA clinic where they will get either an urgent carotid doppler or a weighted MRI (preferred) to determine the territory of ischaemia
28529
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Embolism Transplant
QuestionComment
If a patient with a transient ischemic attack (TIA) has atrial fibrillation (AF), immediate CT head imaging is recommended to rule out hemorrhage before starting anticoagulation therapy. This is because AF increases the risk of stroke, and anticoagulation is often necessary to prevent further events. However, it's crucial to ensure there is no bleeding before initiating anticoagulation
60398
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Malignant Syndrome
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Dr Brighton
QuestionComment
During the exam, if I too can't find a word for 15 mins I'll go to A&E
23501
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Epidermis Tachycardia
QuestionComment
i put rivarox but the aspirin answer doesnt really explain why aspirin is wrong
62095
QuestionComment
I believe it is due to the presense of AF in this patient, if the patient were not in AF i think 300mg aspirin would be the correct answer, hope this helps

62257
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j.g.73
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Vaccine Complement
Concept
Chapter
# Summary

A Transient Ischaemic Attack (TIA), colloquially known as a "mini-stroke", represents a sudden focal neurological deficit of vascular origin, characterised by symptom resolution typically within an hour. The absence of an acute infarct on imaging differentiates it from a stroke. Key signs and symptoms include speech difficulty, or arm/leg weakness or sensory changes. Important differential diagnoses include focal seizures, migraine, and intracranial bleeding. Investigations primarily involve neuroimaging, while management aims at reducing future stroke risk with lifestyle changes, control of vascular risk factors, and initiation of antiplatelet therapy. NICE guidelines recommend immediate referral for individuals with suspected TIA for assessment within 24 hours.

# Definition

A transient ischaemic attack (TIA) is a sudden-onset focal neurological deficit with a vascular aetiology, typically resolving symptoms within less than 1 hour. 

# Epidemiology

TIA is a significant health concern worldwide due to its association with future stroke risk. 

The incidence is 230 cases per 100000 person-years.

Risk factors include:
 
* Hypertension
* Diabetes mellitus
* High cholesterol
* Atrial fibrillation
* Carotid stenosis
* Smoking
* Family history of cardiovascular disease/stroke
* History of cardio-embolic events

# Signs and Symptoms

Patients typically present with a sudden onset of focal neurological deficits which may include:

- Speech difficulty (dysphasia)
- Arm or leg weakness
- Sensory changes 
- Ataxia, vertigo or loss of balance
- Visual disturbance: Homonymous hemianopia, diplopia 

Symptoms of TIA are transient, with most resolving within 1 hour.

# Differential Diagnosis

In assessing for a TIA, clinicians should consider the following differential diagnoses:

- **Stroke**: Persistent symptoms with evidence of ischaemia on MRI imaging
- **Focal motor seizures**: These might be suggested by positive symptoms preceding the weakness, such as shaking.
- **Migraine with aura**: Characterized by a preceding aura which may present with visual disturbances, tingling, or numbness, followed by headache.


# Investigations

To confirm the diagnosis and assess the extent of vascular disease, the following investigations are generally recommended:

- Neuroimaging 
	- The preferred modality is MRI to assess for any evidence of ischaemia, haemorrhage or consider alternative pathologies
- Carotid ultrasound (looking for carotid stenosis
- Echocardiogram (looking for cardiac thrombous)
- 24 hour tape (looking for atrial fibrillation)
- Blood tests (including glucose, lipid profile, clotting factors)


# Management

Patients who have had a suspected TIA should be referred for immediate assessment, ideally to be seen **within 24 hours** of onset of symptoms. The aim of management is to reduce the future risk of stroke and includes:

- Lifestyle modifications (smoking cessation, regular exercise, healthy diet)
- Control of vascular risk factors (hypertension, diabetes, dyslipidaemia)
- Initiation of antiplatelet therapy (e.g., aspirin, clopidogrel) unless contraindicated
- In selected cases, endarterectomy or stenting of the carotid artery might be indicated:
	- > 70% stenosis according European Carotid Surgery Trialists' Collaborative Group criteria (ECST) or
	- > 50% according to North American Symptomatic Carotid Endarterectomy Trial criteria (NASCT)

# References

[Click here for NICE Clinical Knowledge Summaries](https://cks.nice.org.uk/topics/stroke-tia/management/suspected-transient-ischaemic-attack/)
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Transient Ischaemic Attack
Topic
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Neurology
6417
In suspected transient ischaemic attack (TIA), immediate aspirin administration is recommended to reduce the risk of subsequent stroke.
A 65-year-old woman presents to the emergency department with temporary word finding difficulty that lasted for 15 minutes, occurring approximately 2 hours ago. Past medical history includes hypertension and gastroesophageal reflux disease.

Observations on triage were:

- Temperature 36.5°C
- Pulse 90
- Blood pressure (BP) 170/85
- SpO2 98% on room air

An electrocardiogram shows non-valvular atrial fibrillation. On examination, she has no neurological deficits.

Which of the following is the next best step in initial management?
e