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Transient ischaemic attacks

Background knowledge ๐Ÿง 


  • Transient ischaemic attack (TIA) is a temporary period of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia without acute infarction
  • Symptoms usually last less than 24 hours and often resolve within an hour
  • TIA is a warning sign of potential future stroke


  • Incidence: Approximately 50 per 100,000 person-years
  • More common in older adults, particularly those over 60 years
  • Higher prevalence in males compared to females
  • Risk factors include hypertension, diabetes, smoking, hyperlipidaemia, and atrial fibrillation

Aetiology and Pathophysiology

  • Atherosclerosis (most common cause)
  • Embolism (from heart or extracranial arteries)
  • Small vessel disease
  • Hypercoagulable states
  • Pathophysiology: transient reduction in blood flow to the brain, leading to temporary neurological deficits

Clinical Features ๐ŸŒก๏ธ


  • Sudden onset of focal neurological deficits
  • Weakness or numbness of face, arm, or leg (typically one side)
  • Dysphasia (difficulty speaking)
  • Visual disturbances (e.g., monocular blindness, hemianopia)
  • Dizziness, loss of balance or coordination
  • Symptoms resolve within 24 hours


  • Transient neurological signs (weakness, numbness, speech difficulties)
  • Normal neurological examination between episodes
  • Possible carotid bruit on auscultation
  • No permanent neurological deficits

Investigations ๐Ÿงช


  • CT or MRI brain to rule out stroke or other pathology
  • Carotid Doppler ultrasound to assess for stenosis
  • ECG to detect atrial fibrillation
  • Echocardiography if embolic source suspected
  • Blood tests: full blood count, glucose, lipids, clotting profile
  • Consider Holter monitor for intermittent arrhythmias

Management ๐Ÿฅผ


  • Immediate assessment and management to prevent stroke
  • Antiplatelet therapy (e.g., aspirin, clopidogrel)
  • Anticoagulation if atrial fibrillation present (e.g., DOACs)
  • Carotid endarterectomy if significant carotid stenosis
  • Management of risk factors (e.g., hypertension, diabetes, hyperlipidaemia)
  • Lifestyle modifications (smoking cessation, exercise, diet)


  • Increased risk of stroke within the first 48 hours
  • Recurrent TIAs
  • Permanent neurological deficits if progression to stroke
  • Cardiovascular complications (e.g., myocardial infarction)
  • Decreased quality of life due to anxiety about recurrence


  • High risk of stroke, especially within the first 48 hours after TIA
  • Long-term prognosis depends on underlying aetiology and risk factor management
  • Proactive management can reduce risk of future strokes
  • Regular follow-up and monitoring are essential

Key Points

  • TIA is a medical emergency and predictor of stroke
  • Rapid assessment and management are crucial
  • Management focuses on preventing future strokes
  • Control of risk factors and lifestyle modifications are essential
  • Multidisciplinary approach improves outcomes

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