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29 Cards in this Set
- Front
- Back
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TIAs are the ______ of a disease, and not a specific disorder
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symptoms
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RIND stands for
and lasts for |
reversible ischemic neurological deficits
lasts for >24 hrs <3 days |
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stroke warning
___% of patients with TIA will have stroke within 3 years |
25%
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stroke warning
___% of patients with TIA will have stroke within5 years |
33%
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those patients who've had thombotic stroke have a positive Hx of TIA in ____% of cases
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50-66% of cases
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carotid TIAs have these symptoms
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amaurosis fugax, transient aphasia, motor or sensory deficits (bear paw)
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carotid TIAs are associated with moderate ______ and (ulcerative) _______ at the bifurcation of the neck
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stenosis
plaques 70% of carotid TIA patients show these signs |
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carotid TIAs have ______ ocular bruit and ______ Hollenhorst plaque
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contralateral ocular bruit
ipsilateral HH plaque ipsilateral Horner's rare |
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carotid TIAs are associated with carotid _____ and reduced carotid ______
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bruit
pulse |
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symptoms of vertebrobasilar TIAs
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symptoms: aphasia, dizziness, diplopia, ataxia, syncope, loss of consciousness, dysphagia, numbness around lips or face
NON-PARALLEL HEMIPARESIS AND HEMISENSORY LOSS bilateral motor or sensory deficits |
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this is characterized by a narrow subclavian artery proximal to the vertebral artery, thereby stealing away from the vertebral circulation
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Subclavian Steal syndrome
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symtoms of aphasia, dizziness, diplopia, ataxia, syncope, loss of consciousness, dysphagia, numbness around lips or face
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either vertebrobasilar or subclavian steal syndrome TIAs
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stroke is rare with this type of TIA
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subclavian steal syndrome/TIA
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these are the 3 cardiac sources of a TIA
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cardiac embolus
cardiac arrhythmia hypotension |
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_____ symptoms are more common with a cardiac embolus
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carotid TIA symtoms
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these cardiac sources of TIAs have no focal neurological signs
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cardiac arrhythmias
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______ is a cardiac source of TIA that has focal signs in Pts with compromised cerebral circulation
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hypotension
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these are the 5 confounding phenomena of TIAs
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1. migraine (transient global amnesia)
2. focal seizures 3. chronic subdural hematoma (DDx - injury?) 4. unruptured cerebral aneurysms 5. systemic factors (anemia, hyperglycemia, hypoglycemia, polycythemia (increased hematocrit), and thrombocytosis (increased platelet count)) |
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Lancet ABCD system
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Age
Blood pressure Clinical features Duration |
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Age with Lancet system
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Age > 60 years
+1 |
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Blood pressure with Lancet system for TIAs
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> 140/90
+1 |
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Clinical features with Lancet system for TIAs
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facial/arm/leg numbness/paresis
+2 difficulty speaking/understanding +1 |
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Duration with Lancet system for TIAs
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>1 HR
+2 >10 min < 1 HR +1 |
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if Pt has 6 pts or greater with Lancet system, __% chance of stroke within 1 week
Must refer to PCP within ___ HR |
31%
24 HR |
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Workup for TIA patient involves (5)
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1. auscultation for bruits
2. BP (both arms) - less than 10 mm Hg difference 3. ECG 4. Duplex ultrasound 5. MRA or angiography |
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Treatment for Carotid TIA
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1. Carotid Endartectomy
2. Anticoagulant Therapy (for severely narrowed, unoccluded) 3. Antiplatelet agents (ASA, ticlopidine, clopidogrel) for ulcerated or irregular plaques without severe stenosis |
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Vertebrobasilar TIA Treatment
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1. Anticoagulants for large vessel disease with TIAs of less than 2 months
2. Antiplatelet agenst after anticoagulants for 1 year if TIA free 3. If TIA symptoms > 2 months, Tx with antiplatelet agents ONLY |
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Cerebral or basilaer TIA Treatment
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1. Anticoagulants (warfarin) for large vessel disease 4-6 mos.
2. Antiplatelet agents after anticoagulant for 1 year if TIA free |
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Treatment for TIAs with negative workups (40%)
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Anticoagulant then antiplatelet if TIA free
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