This document discusses transient ischemic attacks (TIAs) and cervical artery dissection. It defines a TIA as a temporary episode of neurological dysfunction caused by focal brain or eye ischemia without infarction. It lasts less than 2 hours and is a warning sign of future stroke risk. Cervical artery dissection involves tearing of the inner lining of arteries in the neck, most commonly caused by neck trauma or connective tissue disorders. It can lead to strokes, with headaches and neck pain as early symptoms. Management involves diagnosing the condition with imaging tests like MRI/MRA and treating risk factors to prevent further ischemic events.

1. Dr.Soma Sekhara Reddy
Emergency medicine
T I A and
CERVICAL ARTERY DISSECTION

2. T I A
 Definition :
A transient episode of neurological dysfunction
caused by focal brain, spinal cord, or retinal
ischemia, without acute infarction.

3.  Analogous to unstable angina
 Symptoms – similar to stroke
 Lasts less than 1 or 2 hours
 Resolved on its own
 Warning signal to the future threat

4.  Assessment of the risk of stroke in next 2 days: A B
C D D SCORING
 A – age > 60 yrs
 B – b.p > 140/9o initial recording
 C – clinical features: motor +/- speech
 D – duration and diabetes

5. Management
 Diagnosis :
1. history:
 symptoms
 try to identify risk factors for heart disease and
stroke:
 high blood pressure
 high cholesterol
 diabetes
 smoking and
 family history

6. 2.Physical examination:
 A - Airway
 B - Breathing
 C - Circulation
 Examination of the neck: bruits / gushing sounds
 A full neurologic exam

7.  E C G: arrhythmias and AF
 CT scan : to rule out bleeding not to distinguish
b/n stroke and TIA
 Carotid ultrasound : look for narrowing of the
blood vessels
 CBC and other routines including cholesterols ,PT
and INR if indicated

8. Treatment
 ?
 Prevention of the next..

9. Cervical artery dissection
 Uncommon in general
 Important cause of stroke (10 to 25 %) in young
and middle aged persons
 Can occur in both anterior and posterior arterial
systems
 Can cause transient and persistent symptoms

10. Etiology and risk factors
 Neck trauma - either major or trivial
 Family history of arterial disease and other
genetic factors
 Recent respiratory infection
 Connective tissue disease and
 History of migraine

11. Carotid artery dissection
 U/l headache (50% to 67%) - typical first symptom
of patients with internal carotid artery dissection
 Face pain (10%), or neck pain (25%) - precede other
symptoms by hours to days
 Partial Horner syndrome : miosis and ptosis
 Cranial nerve palsies - in 12% of internal carotid
artery dissection patients.

12. Vertebral artery dissection
 Posterior neck pain (46%)
 Headache (69%) - typically occipital
 Unilateral facial paresthesia
 Dizziness
 Vertigo
 Nausea/emesis

13.  Diplopia and other visual disturbances
 Ataxia
 Limb weakness and numbness
 Dysarthria
 Hearing loss
 Cervical radiculopathy – 1 %

14. If left untreated:
 carotid dissection -cerebral ischemia
retinal infarction rarely
 vertebral artery dissection - posterior circulation
infarction.
 Investigation of choice:
MRI/MRA or CT/CTA

15. conclusion
Before discharging the patient consider:
 MRA / CTA / Carotid Doppler
 Initiate and titrate the dose of anti hypertensives
, anti diabetics and statins
 Counseling about importance of regular
medication and cessation of smoking.

16. Thank you