Neurology · USMLE Step 1 and Step 2

Transient Ischemic Attack song

Transient Ischemic Attack - Workup & Risk, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Transient Ischemic Attack

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Key points in this song10

A TIA is a transient neurological deficit lasting less than 24 hours (typically less than 1 hour) with no infarction on neuroimaging, distinguishing it from ischemic stroke.
The ABCD2 score stratifies short-term stroke risk after TIA: Age ≥60, BP ≥140/90, Clinical features (unilateral weakness = 2, speech disturbance without weakness = 1), Duration ≥60 min = 2, Diabetes = 1; score ≥4 indicates high risk.
The most common cause of TIA is thromboembolism from carotid atherosclerosis; ipsilateral carotid stenosis must be evaluated urgently with carotid ultrasound or CT angiography.
Amaurosis fugax — transient monocular blindness described as a "curtain descending over the eye" — is a classic TIA variant caused by emboli to the ophthalmic artery (branch of the internal carotid artery).
Cardiac sources of emboli (atrial fibrillation, valvular disease, patent foramen ovale) must be evaluated with ECG, echocardiography, and prolonged cardiac monitoring following TIA.
Urgent workup within 24 hours reduces subsequent stroke risk; MRI with DWI is the preferred neuroimaging modality to detect early ischemia and differentiate TIA from completed infarct.
Antiplatelet therapy (aspirin or aspirin plus clopidogrel for 21 days in high-risk TIA) is initiated immediately; dual antiplatelet therapy significantly reduces early recurrent stroke risk.
Carotid endarterectomy is indicated for symptomatic ipsilateral carotid stenosis ≥70% and is most beneficial when performed within 2 weeks of the TIA.
Lacunar TIAs result from small vessel lipohyalinosis in penetrating arteries, classically presenting with pure motor or pure sensory deficits, and are strongly associated with hypertension and diabetes.
Anticoagulation with warfarin or a DOAC (not antiplatelet therapy) is the treatment of choice when TIA is caused by atrial fibrillation, targeting stroke prevention from cardioembolic source.