Transient Ischemic Attack

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The document discusses Bella, a 51-year-old menopausal waitress who presented with numbness and was referred to a GP. Upon examination, the GP wanted to rule out a transient ischemic attack (TIA). TIAs are caused by temporary blockages or clots in arteries supplying blood to the brain, and symptoms last less than an hour. The GP discusses risk factors for TIAs like hypertension, investigations that could be done, treatments including clot-busting drugs and surgery, and prevention through controlling underlying conditions and using anti-platelet medications.

Health & Medicine

Name Presented Case
Mrs X Endometrial
Carcinoma + 2ndary
lung cancer
Mrs S Asthma
Mrs Z Hypertension +
Diabetes
Mr X Asperger’s Syndrome
Mrs PP Chronic hypertension
Bella ?

51 YEAR OLD

MENOPAUSAL

WAITRESS

Bella

SOCIAL HISTORY
Since the age of 15
Stopped about 10 years ago, at age 40

Self explanatory

Physical
Examination
Vital Signs + general observation

Motor
Reflexes
Cerebellar
Sensation
Tone

Impression
Exclude not Transient Ischemic Attack

Investigations

ECG

Doppler Test on the Carotid Artery

TELLING SIGN
OF STROKE!!!

Transient Neurological dysfunction

caused by focal brain/retinal ischemia
without acute infarction

Lasting typically <60 minutes

Followed by function recovery in 24 hours

Sight

Change in alertness
Trouble in speaking

Personality, mood,
Difficulty swallowing
or emotional
changes

Muscle weakness

Confusion

Numbness

Lack of control
Difficulty writing over the bladder
or reading or bowels

Risk Factor
Family History
Non-
Modifiable
Age

Gender

Race

Sickle Cell Disease

Treat underlying diseases
Treat underlying
Hypertension/cholesterol/diabetes/anaemia

diseases

Clot Busters
-tPA/Urokinase

Angioplasty
-Stenting

Surgery
-Bypass/Endarterectomy *Aspirin
Plavix

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Transient Ischemic Attack

1. Good Afternoon.

2. Name Presented Case Mrs X Endometrial Carcinoma + 2ndary lung cancer Mrs S Asthma Mrs Z Hypertension + Diabetes Mr X Asperger’s Syndrome Mrs PP Chronic hypertension Bella ?

3. 51 YEAR OLD MENOPAUSAL WAITRESS Bella

4. NUMBNESS GP’s Visit

5. SOCIAL HISTORY Since the age of 15 Stopped about 10 years ago, at age 40 Self explanatory

6. HYPERTENSION

7. Family History

8. Physical Examination Vital Signs + general observation Motor Reflexes Cerebellar Sensation Tone

9. Impression Exclude not Transient Ischemic Attack

10. Investigations ECG Doppler Test on the Carotid Artery

11.

12. Definition

13. TELLING SIGN OF STROKE!!! Transient Neurological dysfunction caused by focal brain/retinal ischemia without acute infarction Lasting typically <60 minutes Followed by function recovery in 24 hours

14. Sight Change in alertness Trouble in speaking Personality, mood, Difficulty swallowing or emotional changes Muscle weakness Confusion Numbness Lack of control Difficulty writing over the bladder or reading or bowels

15. RISK FACTORS

16. Risk Factor Non- Modifiable Modifiable

17. Risk Factor Family History Non- Modifiable Age Gender Race Sickle Cell Disease

18. Risk Factor Modifiable

19. Plaque Formation

20.

21.

22. Hypertension Polycythemia Anemia

23.

24. Investigations

25. General

26. Specific

27. Treatment

28. Anticoagulant/ Anti-platelet

29. Treat underlying diseases Treat underlying Hypertension/cholesterol/diabetes/anaemia diseases

30.

31.

32. Clot Busters -tPA/Urokinase Angioplasty -Stenting Surgery -Bypass/Endarterectomy *Aspirin Plavix

33.

34. PREVENTION

Editor's Notes

Not on OCP
On 20th Feb 2012, she was at home. She took leave from work that day because last night was very stressful for her. She felt headache, as sat on the sofa, suddenly, everything went blurry. The right side of her body — her arm, face and leg — went numb. She just sat very still. She was confused and scared because she was alone and all her kids were at school. She didn’t know what happened to her and she didn’t know when the numbness will stop. After two hours, symptoms went away almost as quickly as they came. She thought it was caused by headache. And she went off to pick up her kids at school and waited till the next day. On 21st she went to MediAssist4U and seek for health professional’s advice.
General condition….alert. Pulse rate 120/70. temp 37.3 resp rate 14-18 pulse normal rhythm 70 beatsVital signs: bp, breathing rate, heartbeat rate, temperature + pain. Reflex- knee jerkMotor – push pullCerebellar – walkSensation – cotton bud, temp, firm, Tone – resist pressure
Risk factors you can take steps to control You can control or treat a number of risk factors, including:High blood pressure. Risk of stroke begins to increase at blood pressure readings higher than 115/75 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.Cardiovascular disease. This includes heart failure, a heart defect, a heart infection or an abnormal heart rhythm.Carotid artery disease. The blood vessels in your neck that lead to your brain become clogged.Peripheral artery disease (PAD). The blood vessels that carry blood to your arms and legs become clogged.Cigarette smoking. Smoking increases your risk of blood clots, raises your blood pressure and contributes to the development of cholesterol-containing fatty deposits in your arteries (atherosclerosis).Physical inactivity. Engaging in 30 minutes of moderate intensity exercise most days helps reduce risk.Diabetes. Diabetes increases the severity of atherosclerosis — narrowing of the arteries due to accumulation of fatty deposits — and the speed with which it develops.Poor nutrition. Eating too much fat and salt, in particular, increases your risk of TIA and stroke.High cholesterol. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a statin or another type of cholesterol-lowering medication.High levels of homocysteine. Elevated levels of this amino acid in your blood can cause your arteries to thicken and scar, which makes them more susceptible to clots.Excess weight. A body mass index of 25 or higher and a waist circumference greater than 35 inches in women or 40 inches in men increase risk.Heavy drinking. If you drink alcohol, limit yourself to no more than two drinks daily if you're a man and one drink daily if you're a woman.Use of illicit drugs. Avoid cocaine and other drugs.Use of birth control pills. If you use any hormone therapy, talk to your doctor about how the hormones may affect your risk of TIA and stroke.
Risk factors you can't changeYou can't change the following risk factors for transient ischemic attack and stroke. But knowing you're at risk can motivate you to change your lifestyle to reduce other risks.Family history. Your risk may be greater if one of your family members has had a TIA or a stroke.Age. Your risk increases as you get older, especially after age 55.Gender. Men have a slightly higher likelihood of TIA and stroke, but more than half of deaths from stroke occur in women.Sickle cell disease. Also called sickle cell anemia, stroke is a frequent complication of this inherited disorder. Sickle-shaped blood cells carry less oxygen and also tend to get stuck in artery walls, hampering blood flow to the brain.Race. Blacks are at greater risk of dying of a stroke, partly because of the higher prevalence of high blood pressure and diabetes among blacks.
Full-Blood Test – CReactiveProtein (inflammation), CK-BB (damage of brain cells), Hb (viscosity), glucose lvl
Doppler’s Test, EEG, Angiography, Evoked Response Test, PET Scan, MRI Scan, CT Scan
Plavix, Aspirin

Transient Ischemic Attack

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Editor's Notes