All::Neurology::Diseases::Transient ischaemic attack

Intro

What is a transient ischaemic attack?

A brief period of neurological deficit due to vascular cause, typically lasting less than an hour.

What is the tissue-based definition of transient ischaemic attack?

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.

What clinical features are typical of a transient ischaemic attack?

Sudden onset focal neurological deficit resolving typically within 1 hour, including unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, loss of balance, and visual problems such as amaurosis fugax, diplopia, or homonymous hemianopia.

What is the immediate antithrombotic therapy recommended for suspected transient ischaemic attack?

Aspirin 300 mg, unless contraindicated, in which case urgent management discussion is advised.

When is specialist review recommended for transient ischaemic attack?

If the patient has had more than 1 transient ischaemic attack ('crescendo transient ischaemic attack'), suspected cardioembolic source, severe carotid stenosis, or a suspected transient ischaemic attack in the last 7 days.

What investigations are recommended for transient ischaemic attack?

MRI, including diffusion-weighted and blood-sensitive sequences, and carotid doppler.

What secondary prevention measures are recommended for transient ischaemic attack?

Antiplatelet therapy (clopidogrel first-line, aspirin + dipyridamole for intolerance), lipid modification (high-intensity statin), and consideration of carotid artery endarterectomy in specific criteria.