Transient Ischemic attack

 Excerpt from StatPearls, 2024

A transient ischemic attack (TIA) is a medical emergency. It is defined as a transient episode of neurologic dysfunction due to the focal brain, spinal cord, or retinal ischemia without acute infarction or tissue injury. The definition of a TIA has moved from time-based to tissue-based. A TIA typically lasts less than an hour, more often minutes. TIA can be considered a serious warning of an impending ischemic stroke; the risk is highest in the first 48 hours following a transient ischemic attack. Differentiating transient ischemic attack from other mimicking conditions is important. Transient ischemic attacks are usually associated with a focal neurologic deficit and/or speech disturbance in a vascular territory due to underlying cerebrovascular disease. It is always sudden in onset. Evaluation of TIA should be done urgently with imaging and laboratory studies to decrease the risk of subsequent strokes. The subsequent risk of TIA or ischemic stroke can be stratified with a simple clinical measure. Immediate multimodality therapeutic interventions should be initiated. These will include aggressive treatment of blood pressure, high-dose statin, antiplatelet therapy, blood sugar control, diet, and exercises. Specific underlying etiology needs to be managed accordingly. This treatment scheme may substantially reduce the risk of recurrent strokes or future TIA by at least 80%.

StatPearls - NCBI Bookshelf (nih.gov)

Transient Ischemic Attack - StatPearls - NCBI Bookshelf (nih.gov)

"The ABCD2 score is very important for predicting subsequent risks of TIA or stroke. The ABCD2 score was derived from providing a more robust prediction standard. The ABCD2 score includes age, blood pressure, clinical symptoms, duration, and diabetes.

Age: older than 60 years (1 point)
Blood pressure greater than or equal to 140/90 mmHg on first evaluation (1 point)
Clinical symptoms: a focal weakness with the spell (2 points) or speech impairment without weakness (1 point)
Duration greater than 60 min (2 points) or 10 min to 59 min (1 point)
Diabetes mellitus (1 point).

The 2-day risk of stroke was 0% for scores of 0 or 1, 1.3% for 2 or 3, 4.1% for 4 or 5, and 8.1% for 6 or 7. Most stroke centers will admit patients with TIA to the hospital for expedited management and observation if the score is 4, 5, or higher. For patients with a lower score, expedited evaluation and management are still warranted. This expedited approach has been proven to improve the outcome.[9]"

What to do if you have a TIA, or suspect a TIA

 Don't do what I did.  Don't second guess the strange sensation you don't recognize.  You aren't a  doctor.  Just call the squad and let them take you to the Emergency Room at the nearest hospital.  It's sure better than waiting in line with all the other sick or injured people for 2 hours. After I made it through the ER (and had a second episode while waiting for a room) I was put in a room and was asked my name and birthday maybe 10 times and looked at fingers, touched my nose and pressed against hands to see my strength.  Since it was the day after my birthday,  I got many birthday wishes.

I had 2 CT of head/brain without contrast; a CT Angiogram; MRI brain without contrast; MRI brain with Contrast; echocardiogram complete with bubble study and an EKG 12-lead.

TIA Recovery, Tests & Diagnosis | What to Expect After Transient Ischemic Attack (healthgrades.com)

Imaging tests allow your doctor to look for blockages or damage to your brain, carotid arteries (the arteries in your neck that bring blood to your brain), and your heart.

• CT (computed tomography or CAT scan) uses special X-ray equipment and a computer program for a more detailed look at your brain and carotid arteries than an X-ray alone would show.

• MRI (magnetic resonance imaging) provides a more specialized view of the brain using magnetic waves rather than radiation like X-rays.

• Magnetic resonance angiography (MRA) is similar to an MRI, but first the doctor injects a dye through an intravenous (IV) line. The doctor watches the dye’s movement on a screen as the dye moves through the blood vessels throughout your body including the brain. .  .  . 

TIA Prognosis and Outcome

A TIA is a medical emergency not because if its symptoms, but because of what a TIA means. Having a TIA is a warning that something is wrong with your vascular system and you are at risk for stroke. Doctors use a risk score—the ABCD2 score—to determine your risk for stroke after TIA. The score takes into account the following: 

• A: Age: 1 point if you are older than 60 years

• B: Blood pressure: 1 point if the systolic (upper) number is higher than 140 or the diastolic (lower) number is higher than 90

• C: Clinical features: 1 point if your speech was affected but you don’t have any weakness; 2 points if you have weakness, with or without speech difficulties

• D: Duration: 1 point if the duration of the TIA was between 10 to 59 minutes; 2 points if it has been 60 minutes or longer

• D: Diabetes: 1 point if you have diabetes 

If you score a 6 or 7, there is an 8% risk of a stroke within 48 hours after the TIA. If you have a score of 4 or less, the risk is 1%. It’s important to keep in mind these percentages don’t mean you will have a stroke. They indicate your risk without treatment.

The definition of a TIA emphasizes that it is a transient, or temporary event. Therefore, TIA recovery occurs when the symptoms have gone away completely. If the symptoms do not go away, this is not a TIA, but a stroke.

Tuesday, June 08, 2021

Health equity?

Demands for "health equity" for racial and ethnic groups is a push for more government control. The CDC reported in 2014 that the 5 top causes of death were diseases primarily of personal behavior, 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. These are most often a result of obesity, smoking, drinking, drugs, lack of exercise and other risky behavior. HIV rates are still very high among young black men who have sex with men, and CDC says risk factors are poverty, high rates of unemployment, and cultural stigmas. Doesn't mention risky sex. I'm no doctor or researcher, but any poor, unemployed man who doesn't have sex with men will not be at risk for HIV.  The costs of unintentional injuries are huge--motor vehicle, drugs, suicide,  work, falls. The burden on employers and society in general runs in the billions of dollars annually. . . $1,097.9 billion 

Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010 (cdc.gov)

How Many People Die From HIV/AIDS Each Year? (verywellhealth.com)

Health Risks of Overweight & Obesity | NIDDK (nih.gov)

Societal Costs - Injury Facts (nsc.org)

Subscribe to: Comments (Atom)