11/14/24, 10\:39 AM Transient Ischaemic Attack (TIA)

Transient Ischaemic Attack (TIA)

Table of contents
Key points ⚡
Succinct notes to superpower your revision
Transient ischaemic attack (TIA)\: sudden onset focal neurologic de
Urgency\: may indicate impending stroke; >1 in 12 patients will have a recurrent stroke within one week without intervention.
Aetiology\: temporary non-functioning of brain area due to disrupted blood
neurologic de
Risk factors\: age >55, male sex, smoking, hypertension, atrial
Clinical features\: sudden onset, short duration (\< 10 minutes), weakness, numbness/tingling, speech problems, vision
changes, dizziness, headache.
Di
Investigations\: ECG (identify atrial
ultrasound, echocardiography.
Acute management\: 300mg aspirin immediately, referral to stroke specialist within 24 hours, screen for atrial
carotid stenosis, dual antiplatelets for 21 days, initiate secondary prevention (lifestyle, statin, smoking cessation,
hypertension/diabetes management).
Special cases\: atrial
endarterectomy).
Carotid endarterectomy\: removes atherosclerotic plaque, recommended for 70-99% stenosis within two weeks, 50-69%
stenosis at centres with \<6% complication rate.
Complications\: increased stroke risk, long-term disability, cognitive impairment; high recurrence risk within
especially with atrial
Article 🔍
A comprehensive topic overview

Introduction

A transient ischaemic attack (TIA) is a sudden onset focal neurologic de
1
A TIA is an urgent condition, as it may serve as a warning sign for an impending stroke. Without intervention, more than 1 in
12 patients will have a recurrent stroke within one week.
2

Aetiology

TIA involves a temporary non-functioning of a focal area of the brain due to disruption of the blood
3
This disruption is typically caused by an embolus, a dislodged blood clot that can travel in the bloodstream and block
cerebral arteries. The reduced blood
neurologic de
If blood
de
https\://app.geekymedics.com/notebook/2795/ 1/511/14/24, 10\:39 AM Transient Ischaemic Attack (TIA)
Atrial and carotid stenosis are the most important causes to identify, as these have a higher rate of early
recurrent stroke.

Risk factors

Risk factors for TIA include\:
4
Age\: TIAs are more common in adults over 55
Sex\: men are at a slightly higher risk than women
Smoking
Hypertension
Atrial
Diabetes
Family history of stroke or TIA
Prior TIA or stroke
Vasculitis

Clinical features

The clinical features of a TIA vary depending on the arterial territory involved.
The most important clinical features to identify are the sudden onset of symptoms and short duration. These two features
help di
The clinical features should appear immediately. The average duration of a TIA is less than 10 minutes. Only 1 in 4 sudden
neurological attacks self-resolve as TIA; 3 in 4 will remain as a permanent stroke.
TIAs can present with a wide range of neurological symptoms, including\:
5
Weakness\: temporary weakness or paralysis, often on one side of the body (hemiparesis)
Numbness or tingling\: brief episodes of numbness or a "pins and needles" sensation, often a
body
Speech problems\: slurred speech (dysarthria) or di
Vision changes\: transient vision disturbances, such as loss of vision, double vision (diplopia), or loss of vision in one eye
(amaurosis fugax)
Dizziness or loss of balance\: sudden dizziness, loss of balance, or di
coordination problems
Headache\: although less common, some individuals may experience a sudden and severe headache during a TIA
For more information, see the Geeky Medics guide to stroke and TIA history taking.

Di

Possible di
2
Hypoglycaemia
Migraine aura\: di
visual change or numbness > 5 minutes (as opposed to sudden, completed at onset in TIA)
Seizure (much more likely to include loss of awareness)
Syncope
The clinical features, rather than investigations, are most useful in identifying TIA and distinguishing it from these
di
https\://app.geekymedics.com/notebook/2795/ 2/511/14/24, 10\:39 AM Transient Ischaemic Attack (TIA)

Investigations

The most important investigations in TIA are an ECG (to identify atrial ) and carotid artery imaging (for
symptomatic carotid stenosis), as these conditions carry higher recurrent stroke risk and alter management.

Bedside investigations

Relevant bedside investigations include\:
6
12-lead ECG\: to determine if symptoms are linked to a cardiac source (e.g. atrial

Laboratory investigations

Relevant laboratory investigations include\:
6
Full blood count\: as a baseline
Blood glucose levels\: to identify diabetes
Lipid pro
Coagulation screen
ESR\: to exclude giant cell arteritis in ocular TIA or patients with a headache

Imaging

Relevant imaging investigations include\:
6
CT brain\: to rule out bleeding, tumours, or other structural abnormalities
MRI brain\: to identify acute ischemic changes; the absence of acute ischaemic changes despite an attack lasting more
than 3 hours can also be helpful to suggest a non-vascular cause such as migraine aura
CT angiography and MR angiography\: to visualise blood vessels in the brain and neck to identify any blockages or
abnormalities
Carotid ultrasound\: to assess blood
Echocardiography\: to investigate for cardiac source of emboli

Management

Unresolved acute neurological deacute stroke and referred urgently for
acute stroke service assessment.
According to the 2023 British and Irish Association of Stroke Physicians Guidelines, the acute management for fully
resolved TIAs involves\:
300mg aspirin immediately
Referral for assessment within 24 hours by a stroke specialist clinician
Screen for atrial and carotid stenosis*
If TIA is con
and load additionally with clopidogrel 300mg stat, then 75mg daily
Initiate secondary prevention\: lifestyle advice, statin, smoking cessation, hypertension and diabetes management
*These underlying aetiologies alter the acute management of TIA\:
Atrial
Symptomatic carotid stenosis\: consider carotid endarterectomy
Carotid endarterectomy
Carotid endarterectomy is a surgical procedure aimed at removing atherosclerotic plaque from the carotid artery,
which is performed to lower the risk of stroke or transient ischaemic attacks in the future. It carries a risk of stroke and
damage to local structures.
It is recommended if\:
70-99% internal carotid artery stenosis\: preferably performed within the
https\://app.geekymedics.com/notebook/2795/ 3/511/14/24, 10\:39 AM Transient Ischaemic Attack (TIA)
50-69% stenosis\: recommended but only at centres with perioperative complication rate \<6%.

Complications

The main complication of a TIA is the increased risk of subsequent strokes with long-term disability and cognitive
impairment.
1
As discussed, the recurrence rate is signi
Atrial
>70% carotid stenosis\: the 1-year risk may be as high as 16%
Many of these recurrences will occur within the
The annual recurrence risk for non-AF non-carotid TIA is below 2%.

References

National Institute of Neurological Disorders and Stroke. T r a n s i e n t I s c h e m i c A t t a c k ( T I A ) . Published in 2023. Available from\:
[LINK]
Wilkinson, et al. O x f o r d H a n d b o o k o f C l i n i c a l M e d i c i n e . Published in 2017. Oxford University Press
Panuganti KK, Tadi P, Lui F. T r a n s i e n t i s c h e m i c a t t a c k . In\: StatPearls [Internet]. Published in 2023. Available from\: [LINK]
Khare S. R i s k f a c t o r s o f t r a n s i e n t i s c h e m i c a t t a c k \: A n o v e r v i e w . Published in 2016. Available from\: [LINK]
Lewandowski CA, Rao Available from\: [LINK]
CPV, Silver B. T r a n s i e n t i s c h e m i c a t t a c k \: d e
Coutts SB. D i a g n o s i s a n d m a n a g e m e n t o f t r a n s i e n t i s c h e m i c a t t a c k . Published in 2017. Available from\: [LINK]
NICE. S t r o k e a n d t r a n s i e n t i s c h a e m i c a t t a c k i n o v e r 1 6 s \: d i a g n o s i s a n d i n i t i a l m a n a ge m e n t . Published in 2019. from\: [LINK]
Available

Reviewer

Professor Simon Cronin
Consultant Neurologist
Cork University Hospital and School of Medicine, University College Cork

Aphasia
Benign Paroxysmal Positional Vertigo (BPPV)
Cervical Radiculopathy
Chiari Malformations
Down's Syndrome

Test yourself

https\://app.geekymedics.com/notebook/2795/ 4/511/14/24, 10\:39 AM Transient Ischaemic Attack (TIA)