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TIA — SCE Neurology MCQ

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HardSecondary Prevention of StrokeTIASCE Neurology

A 34-year-old has recurrent right-sided TIAs precipitated by dehydration. Catheter angiography shows bilateral terminal internal-carotid stenosis with basal collaterals, and perfusion imaging demonstrates impaired cerebrovascular reserve in the left hemisphere. What is the most appropriate disease-modifying plan?

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Correct answer: D — Refer for expert-centre assessment of direct or combined cerebral revascularisation

The angiographic pattern is moyamoya angiopathy, and recurrent ischaemic symptoms with impaired haemodynamic reserve identify an adult who should be assessed for revascularisation in an experienced centre. Antiplatelet treatment may be used selectively but does not restore reserve. Angioplasty is limited by restenosis and vessel fragility, endarterectomy does not address terminal intracranial disease, and chronic induced hypertension is not a durable disease-modifying strategy.

Reference: European Stroke Organisation guideline on moyamoya angiopathy (Published March 2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10069176/