Symptoms of TIA/ Cerebral ischemia

Carotid territory TIA; - sudden monocular blindness, hemianesthesia , hemiperisis,transient
aphasia (dominant lobe affected)
• Vertibrobasilar territory:
unconsciousness (reticular formation) Drop –attacks
(Non specific dizziness on its own is not diagnostic of TIA of posterior circulation.)
 Bilateral limb motor /sensory dysfunction
Diplopia, Dysarthria, vertigo, tinnitus, P a g e | 11

 Dysarthria and ataxia ofcerebellar lesion
Cortical blindness /homonymous hemianopia
Natural history of TIA: 10% develop infarction in the following year
Another 10% in next year. Greatest incidence in 3-6mths after initial TIA
• OFTEN THERE IS NO WAY TO DIFFERENTIATE TIA FROM ACUTE STROKE.
• DO NOT WAIT TO SEE IF SYMPTOMS GO AWAY
• HOWEVER RISK OF TIA DEVELOPING FUTURE STROKE CAN BE EVALUATED USING ABCD
SCORE
Learning point:
It is important for lay person to know and recognize stroke symptoms so that speedy reach to the
hospital is made.
1. G. Stroke in evolution:
Neurological deficit that progresses under observation (sometimes fluctuates)
Possible mechanism: (Physical and chemical changes)
A. propagating thrombus obliterating collateral branches thus enlarging territory of
ischemia.
B. progressive narrowing of the vessel by thrombus
C. cerebral edema.
D. enlarging intra cerebral hematoma from continued hemorrhage.
E. emboli –propagating, migrating, lysing and dispersing.
F. recurrent artery to artery embolisation.

.1.H. Completed stroke:
 Where neurological deficit does not progress further.
1. I. Lacunar infarct:
Very small infarct measuring ½ -1cm in diameter.
Cause –local small vessel disease –Block of local small penetrating
branches of major intra cranial arteries.
Resolution: the infarct which consists of neurons and glial tissue
degenerate and eventually are absorbed by activated microglial cells.
Finally a cystic cavity or glial scar remains.
it is found in poorly controlled hypertensive.
Hypertension occludes these vessels by –lypohyalinisation, fibrin
deposition, and micro atheroma.
Final outcome: Lacunar infarcts are multiple and eventually lead to,
dementia and pseudo bulbar palsy.