A 'Transient Ischemic Attack' or TIA is a transient episode of focal neurological or retinal dysfunction due to an impaired supply of blood to a particular territory of the brain. The reduction or cessation of blood flow to the brain is responsible for the sign and symptoms of a transient ischemic attack. The loss of brain function is sudden, usually unprovoked and reaches its maximun over 1 to 5 minutes. The interference with the blood supply to the brain lasts usually less than an hour and most individuals fully recover in less than 24 hours.
A person who has suffered a TIA has a risk of developing a stroke of up to 10% within the following 30 days and up to 20% at three months. The risk of suffering a subsequent stroke is at least 3 times greater for individuals who have had a TIA than for those individuals who never had a TIA. Recent studies suggest that half of the strokes that occur following a transient ischemic attack occur within 48 hours following a TIA.
The ABCD score (Oxfordshire Community Stroke Project) is used to stratify the 30-day stroke risk in patients that have suffered a transient ischemic attack (TIA). The ABCD score is based on points summed from 5 clinical factors:
Clinical features including unilateral weakness
Speech impairment without weakness
Duration of Impairment
A newer ABCD2 (squared) score includes a 6th factor such as diabetes to increase its validation.
Transient ischemic attack (TIA) may cause a variety of visual symptoms that include partial loss of vision or complete blindness, double vision, abnormal eye movements, blurred vision. A sudden onset of a visual fog, visual haze, visual blur, visual cloud or visual mist is known as 'Amaurosis Fugax'. The length of visual loss can be as short as 1 to 5 minutes and rarely lasts longer than 30 minutes. Following an episode of Amaurosis Fugax the vision is usually fully restored with very few patients having permanent visual loss due to a retinal infarction.
The most common causes associated with transient ischemic attacks (TIA) include carotid and vertebral artery atherosclerotic occlusion. Occlusion of one or more of these vessels is the single largest cause of TIAs. Risks factors associated with transient ischemic attack (TIA) include:
History of substance abuse (cocaine)
The first medical provider that comes into contact with a patient that is experiencing or had experienced a TIA recently, is in the best position to limit the progression of a TIA to a stroke. Careful consideration should be given to the rapid administration of antiplatelet or anticoagulation therapy. Intensive diagnostic workup including laboratory studies and radiologic imaging studies are essential to make a diagnosis of the underlying condition. Immediate and long term serial neurologic examinations are essential.
Initial diagnostic evaluation of a patient suffering a transient ischemic attack (TIA) must include:
Complete blood count with platelet count (CBC)
Chemistry profile including a cholesterol
Prothombin time and activated thromboplastin time
Erythrocyte sedimentation rate with syphilis serology
Brain CT scan
Coronary artery disease assessment
Because almost one third of patients who had experienced a TIA will suffer a stroke within the following 5 years, the goal of treatment is to prevent another TIA or stroke by identifying and treating the underlying cause. Antiplatelet or anticoagulation treatment is useful. Carotid endarterectomy or stenting is indicated in patients with critical carotid artery stenosis. Additional recommendations for prevention of modifiable TIA risks include:
Hypertension should be aggressively treated
Coronary artery disease and arrhythmias should be treated
Cholesterol levels and hyperlipidemia should be treated
Cigarette smoking should be discontinued
Excessive alcohol ingestion should be eliminated
Use of illicit drugs must be eliminated
Diabetes should be monitored and controlled
Hormone ingestion in women should be discontinued
A patient with neurologic deficits that worsen progressively is considered to have a stroke in evolution. Because it is extremely difficult to differentiate between a patient suffering a TIA and a patient with a stroke in evolution, intensive diagnosis and treatment should be provided to all patients experiencing signs of brain ischemia. Transient ischemic attack (TIA) should be considered to the brain what angina is to the heart; a serious event with potentially very serious complications. Early, aggressive treatment of patients who have suffered a transient ischemic attack significantly reduces the risk of recurrent stroke.
Medications known as antiaggregation agents are used to prevent strokes in patients who have suffered a transient ischemic attack (TIA). Aspirin, clopidogrel, ticlopidine and dipyridamole are some of the drugs used for this purpose. Some of the latter medications are used in combination with aspirin to increase their efficacy in preventing strokes.
If you are suffering from complications due to a delayed diagnosis of a transient ischemic attack (TIA) or stroke, or the failure to evaluate and treat a transient ischemic attack (TIA), let Dr. Borten and the Boston area medical malpractice attorneys at Gorovitz & Borten review the specifics of your case. At Gorovitz & Borten we have the necessary experience, understanding and resources available to properly evaluate the complications of a stroke, and give you a timely assessment of its merits.
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