Transient Ischaemic attack Dr Moien Khan

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Transient Ischaemic attackDr Moien Khan
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Risk Facts/Epidemiology

• Stroke third cause of death
• Half of strokes- people over 70
• NHS cost 2.3 billion pounds
• Stroke prevention
• Many stroke patients have had TIA
• 25 - 50 in large artery atherothrombotic
  strokes
• 11 - 30 in cardioembolic strokes
• 11 to 14 in lacunar strokes

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Stroke Rate After TIA Percent (95 CI)
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• What is a TIA?
• Acute loss of focal cerebral function
• Symptoms last less than 24 hours
• Due to inadequate blood supply
• Thrombosis
• Embolism

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Presentation

• Carotid artery territory
• (anterior circulation)
• Hemiparesis (unilateral weakness)
• Aphasia / dysphasia (speech disturbance)
• Unilateral sensory loss or inattention
• Homonymous hemianopia with any of the above)
• Visual inattention (ignoring visual stimuli)
• Amaurosis Fugax (loss of vision in one eye)

• Vertebral artery territory
• (post circulation)
• Diplopia (double vision)
• Dysarthria (slurred speech)
• Incoordination and unsteadiness
• Isolated homonymous hemianopia (visual loss to
  one side
• Nausea and Vomiting
• Dizziness

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Differential Diagnosis
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Risk Factors
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Role of primary care

• Primary prevention
• Identify patients at high cardio vascular risk
• Addressing Risk factors
• Appropriate advice ,support and treatment,
• Regular Review to those at risk of stroke
• Secondary prevention

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Expected Outcome TIA with Atrial Fibrillation

• Rate of stroke
• Placebo - 12 per year
• Aspirin - 10 per year
• Warfarin - 4 per year
• Major bleed in 2.8 per year
• No increase in ICH occurrence

EAFT Study Group, Lancet, 1993
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Management
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GMS contract

• Register for all patients
• Smoking status ,cessation advice
• Recording and monitoring BP
• Cholestrol
• Aspirin
• Influenza immunization

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• Thanks

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