Causes of TIAs:
- thromboembolism
- chiefly from carotids
- may be from heart - AF, mural thrombus etc)
- hyperviscosity
- myeloma
- polycythaemia
- sickle cells
- very high white cells
Management depends on the ABCD2 score, which is calculated as shown below:
- age >60 : 1 point
- BP greater or equal to 140/90 : 1 point
- clinically:
- unilateral weakness : 2 points
- speech disturbance without weakness : 1 point
- duration
- >60 mins : 2 points
- 10 - 59 mins : 1 point
- diabetes : 1 point
ABCD2 score of 4 or more, or crescendo TIAs (=2 or more in one week):
- specialist review within 24 hrs
- start 300mg aspirin OD
ABCD2 score of 3 or below, or symptoms >1 week ago:
- specialist review within a week
- start 300mg aspirin od
After specialist review, usually 75mg aspirin OD and dipyridamol OD for 2 yrs.
If pt is aspirin intolerant, prescribe monotherapy of clopidogrel.
If assessed to be a candidate for carotid endarterectomy, imaging should be performed within 1 week of symptom onset and if carotid stenosis of:
- 50–99% according to NASCET criteria, or
- 70–99% according to ECST criteria
Remember pt must inform DVLA and no driving for 1 month (car) or 1 yr (lorry). This increases to 3 months for car if multiple TIAs.
Of course other risk factors (hypertension, alcohol, smoking, etc etc etc) should also be addressed.
Differentials for TIA may include:
- migraine
- epilepsy
- hypoglycaemia
- malignant hypertension
- MS
Lets move on to tackle epilepsy...
