Transient Ischemic Attacks (TIAs)

Table 1

Differential Diagnosis of TIA and Stroke

Hemorrhagic

Subarachnoid

Ruptured berry aneurysm
Arteriovenous malformation
Coagulopathy (warfarin, vitamin K deficiency, thrombocytopenia, consumptive coagulopathy)
Infectious endocarditis
Vasculitis
Idiopathic

Intracerebral

Hypertensive (80%)
Arteriovenous malformation
Congophilic angiopathy
Tumor
Coagulopathy

Ischemic

Large vessel atheromatous disease with thrombosis

Aorta Carotid bifurcation
Distal (intracranial) vertebral, proximal basilar artery
Carotid siphon

Microvascular

Microvascular hyaline degeneration
Microatheroma
Incursion of large vessel plaque on small vessel lumen

Systemic embolism

Atrial fibrillation
Acute myocardial infarction
Ventricular aneurysm
Mechanical prosthetic heart valves
Dilated cardiomyopathy (peripartum, alcoholic, post-viral, decompensated ischemic/hypertensive)
Endocarditis (infectious, marantic)
Mitral stenosis
Atrial appendage thrombi
Mitral valve prolapse
Paradoxical (right to left cardiac shunt)
Atrial myxoma

Collagen vascular disease, vasculitis

Systemic lupus erythematosus
Systemic necrotizing vasculitis (polyarteritis nodosa, Wegener's granulomatosis)
Temporal arteritis
Primary central nervous system angiitis
Herpes zoster ophthalmicus vasculopathy

Migraine

Vasculopathies of undertermined origin

Reversible cerebral vasospasm ("thunderclap headache")
Encephalopathy, hearing loss and retinal arterial occlusion (Susac's syndrome)
Large vessel vasculopathy with secondary Moya-Moya syndrome

Tumor

Masquerading as stroke
Intravascular lymphoma

Seizure (Todd's paralysis)

Coagulopathy

Pregnancy/post-partum
Oral contraceptives
Antiphospholipid antibodies
Prothrombin G20210A polymorphism
In case of patent foramen ovale only: risk factors for venous thrombosis (Protein S deficiency, Protein C deficiency, Antithrombin III deficiency, activated protein C resistance (usually Factor V Leiden))

Trauma (carotid, vertebral artery intimal tear)

Blood dyscrasias

Thrombocytosis
Leukemia
SS, SC disease

Endothelial disease

Thrombotic thrombocytopenic purpura
Disseminated intravascular coagulation

Infection

Meningitis
Encephalitis
Syphilis
Parameningeal (aspergillus, mucormycosis)

Drug abuse

Cocaine, phenylpropanolamine, methamphetamine

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Caring for the Older Adult I
copyright University of Florida Geriatric Education Center, 2001