1. Pathophysiology
1.1. Atherosclerosis
1.2. Embolism
1.3. Vasospasm
1.4. Hypoperfusion
1.5. Microvascular disease
1.6. Endothelial injury
2. Etiology (Gu et al., 2021)
2.1. Vascular causes
2.1.1. Atherosclerosis
2.1.2. Small vessel disease
2.1.3. Arterial embolism
2.1.4. Arterial dissection
2.2. Cardiac causes
2.2.1. Artrial fibrillation
2.2.2. Recent myocardial infarction
2.2.3. Valvular heart disease
2.2.4. Patent foramen ovale
2.3. Hematological causes
2.3.1. Hypercoagulable states
2.3.2. Sickle cell anemia
2.3.3. Polycythemia
2.4. Systemic causes
2.4.1. Hypoperfusion
2.4.2. Severe anemia
2.4.3. Vasospasm
3. Risk factors (Amin et al., 2023)
3.1. Age
3.2. Hypertension (chronic high blood pressure damage to the vessels
3.3. Smoking
3.4. Diabetes Mellitus
3.5. Dyslipidemia
4. References
4.1. Amin, H. P., Madsen, T. E., Bravata, D. M., Wira, C. R., Johnston, S. C., Ashcraft, S., ... & Esenwa, C. (2023). Diagnosis, workup, risk reduction of transient ischemic attack in the emergency department setting: a scientific statement from the American Heart Association. Stroke.
4.2. Poledník, I., Sulzenko, J., & Widimsky, P. (2021). Risk of a coronary event in patients after ischemic stroke or transient ischemic attack. Anatolian Journal of Cardiology, 25(3), 152.
4.3. Gu, H. Q., Yang, X., Wang, C. J., Zhao, X. Q., Wang, Y. L., Liu, L. P., ... & Wang, Y. J. (2021). Clinical characteristics, management, and in-hospital outcomes in patients with stroke or transient ischemic attack in China. JAMA network open, 4(8), e2120745-e2120745.
4.4. Krishnan, K., Nguyen, T. N., Appleton, J. P., Law, Z. K., Caulfied, M., Cabrera, C. P., ... & Bath, P. M. (2023). Antiplatelet resistance: a review of concepts, mechanisms, and implications for management in acute ischemic stroke and transient ischemic attack. Stroke: Vascular and Interventional Neurology, 3(3), e000576.
5. Blood pressure monitoring >140/90 mmHg or >130/80 mmHg high-risk groups
6. Signs and Symptoms
6.1. Sudden body numbness or weakness of the face, arm or leg
6.2. Dizziness
6.3. Confusion
6.4. Difficulty talking or understanding speech
6.5. Problems with walking
6.6. Trouble seeing in one or both eyes
6.7. Loss of balance and coordination
7. Complications
7.1. Renal/ kidney failure
7.2. Progression to stroke: High risk of developing an ischemic stroke
7.3. Recurrent Transient Ischemic attacks
7.4. Cognitive decline
7.5. Functional impairments
7.6. Chronic vascular damage (Amin et al., 2023)
7.7. Psychological impact
7.8. Disability and effect on quality of life
7.9. Falls and injuries (Krishnan et al., 2023)
8. Diagnostic tests
8.1. Cardiac Evaluation (Krishnan et al., 2023)
8.1.1. Electrocardiagram
8.1.2. Echocardiography (Transthoracic and transesophageal)
8.1.3. Holter monitoring
8.2. Laboratory tests (Gu et al., 2021):
8.2.1. Complete blood count
8.2.2. Coagulation profile
8.2.3. Blood Glucose and HbA1c
8.2.4. Inflammatory Markers for C-reactive protein or erythrocyte sedimentation rate to detect systemic inflammation
8.2.5. Lipid profile
8.2.6. Hypercoagulability panel
8.3. Imaging
8.3.1. Mangetic Resonance Imaging with diffusion-weighted imaging
8.3.2. Computed tomograpy scan for brain abnormalities
8.3.3. Transcranial Doppler Ultrasound
8.3.4. CT Angiography or MR angiography
8.3.5. Carotid ultrasound
8.4. Ophthalmologic examination
8.5. Toxicology screening to rule out drug-induced vasospasm
9. Treatment options
9.1. Non-pharmacological (Amin et al., 2023)
9.1.1. Lifestyle modifications e.g. smoke cessation, regular aerobic excercises, heart-healthy diet such as low saturated fat conent, high fruit and vegetable intake
9.1.2. Regular physical activity
9.1.3. Blood Pressure Control to < 130/80 mmHg
9.1.4. Smoking cessation
9.1.5. Behavioral and Psychological interventions
9.1.6. For patients with significant carotid artery stenosis > 50%
9.2. Pharmacological (Polednik et al., 2021)
9.2.1. Anticoagulation therapy for cardioembolic causes. Warfarin and Direct Oral Anticoagulants
9.2.2. Antiplatelet therapy to reduce platelet aggregation including clopidogrel, aspirin-dipyridamole
9.2.3. Statins e.g. atorvastatin
9.2.4. Antihypertensive therapy
9.2.5. Thrombolytics
9.2.6. Glucose management e.g. insulin or oral hypoglycemic agents
9.3. Possible referrals
9.3.1. Neurologist: With recurrent TIA, complex nuerological complications or suspected stroke risk
9.3.2. Cardiologist for cardiac causes of embolism e.g. atrial fibrillation, valvular disease
9.3.3. Vascular surgeon for assessment and possible intervention for carotid artery stenosis