Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Transient Ischemic Attack
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

  • Age
  • Blood pressure
  • 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:

  • Transient hypertension
  • Hypercoagulable states
  • Platelet aggregation
  • Dysrhythmia
  • Vasospasm
  • Vasculitis
  • 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
  • Lipid profile
  • Electrocardiogram
  • Brain CT scan
  • Brain angiography
  • 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.
Contact Information
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(when possible), please contact us by phone, fax or e-mail with your question
or concern.

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