Carotid (most common):
Vertebrobasilar:
Alternating paresis or sensory loss
Bilateral sudden visual loss
Diplopia, Ataxia, Vertigo, dysphagia - at
least 2 of these simultaneously
Hemiparesis
Hemisensory loss
Dysphasia
Amaurosis fugax
Amaurosis fugax:
Acute vision loss in one eye
Due to passage of embolism through retinal arteries
Obstruction may be visible using opthalmascope
Often first sign of internal carotid stenosis
Transient global amnesia:
Clinical features:
Episodes of amnesia lasting several hours
Most often in > 65
followed by complete recovery
Episodes presumed to be caused by posterior circulation
ischaemia
Trademark TIA is the sudden loss of focal
CNS function- syncope, confusion,
dizziness.
Typically last minutes to hrs, but < 24 hrs
The arterial area of the TIA will determine
the symptoms
Risk factors:
Hypertension
Smoking
Lifestyle
Hypercholesterolaemia
Atrial Fibrillation
diabetes
Obesity
Alcohol
Clinical findings:
Evidence of source of embolus:
Carotid bruit
Atrial fibrillation
Valvular heart disease
Recent MI
Endocarditis
evidence of underlying condition:
Atheroma
Hypertension
Postural hypotension
Diabetes
Bradycardia
Reduced cardiac output
TIA
Aetiology:
Most commonly caused by thrombosisembolism caused by atheromatous neck
vessels
Investigations:
Prognosis:
Risk of stroke 5 years post TIA is 7%
15% of patients with stroke will have had a
previous TIA
Management:
Modification of risk factors
Anti platelet drugs (aspirin)
Anticoagulants (warfarin)
Carotid endarterectomy
Differential DX:
Migraine with aura
Partial epilepsy
Vestibular disorders
Hypoglycaemia
Psychogenic
Often best diagnosed from Hx
FBC
ESR
BM
ECG
CT
Carotid USS
Blood cultures - if bacterial endocarditis
suspected