Temporary (usually embolic from carotid atheroma) occlusion of cerebral circulation causing focal neurological deficit lasting <24h.
Amaurosis fugax: Temporary occlusion of retinal artery lasting <24h.
High incidence: 0.4 per 1000 per year
Highly predictive of future CVA and MI (composite risk almost 10% per year)
- Focal neurology (see ischaemic stroke)
- Carotid bruit: High grade stenosis, bruit can be absent
- Cardiac murmur
- Atrial fibrillation
- Peripheral vestibular disease
- FBC, ESR
- U&E, CRP, Lipids
- Non-contrast CT – signs of acute infarct?
- ECG/Holter – rule out AF
- Echocardiogram – rule out valvular heart disease, thrombus, PFO
- Carotid doppler +/- angio
- RCP 2016 (UK): Clopidogrel monotherapy
- Meta-analysis of the various combinations that have previously been advocated (dual antiplatelets vs. aspirin, dual vs. clopidogrel, dual with ticagrelor or prasugrel vs. aspirin, aspirin vs. clopidogrel etc.) revealed that in the secondary prevention cohort there was no additional benefit to dual antiplatelet therapy when compared to clopidogrel [ref]
- The results are driven by the findings of the MATCH trial [ref] which concluded that…
- If cardioembolic, consider warfarin
- If carotid artery stenosis >50%, consider carotid endarterectomy, depending on preoperative risk, or endovascular stenting
- Blood pressure control
- Driving: No driving for 1 month, inform DVLA if multiple, or prolonged deficit