Stroke and Transient Ischemic Attacks of the Brain and Eye
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
The capacity to couple a “tissue clock” and “time clock” with effective reperfusion has reignited efforts to evaluate neuroprotective therapies in potentially recoverable acute ischemic stroke. Hemorrhagic vascular malformations are surgically excised if accessible, whereas hemorrhagic dural arteriovenous fistulas and distal/mycotic aneurysms may be treated with embolization if feasible. Modern advances in minimally invasive surgical management of primary, supratentorial intracerebral hemorrhage are being tested in clinical trials. The burden of stroke is also increasing among young adults and is greatest in developing countries. An improved commitment to disparities in stroke burden and access to appropriate and affordable stroke care between countries and regions of different income levels is needed. Patients with transient ischemic attack and mild ischemic stroke share similar age and sex distributions, prevalence of vascular risk factors, causes, and long-term prognosis for serious vascular events. In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women.
Migraine: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache, 2018
Many famous individuals from the worlds of arts and sciences have suffered from migraine headaches. Formal diagnostic criteria for migraine and other headache disorders were published by the International Headache Society (IHS) in 1988; however, these remain a guide and have a well-recognized group of false-negatives. This chapter describes the migraine attack and its variants and their acute and preventive treatment based, in part, on the presence of any coexistent or comorbid disease. The typical headache of migraine is unilateral, throbbing, moderate to marked in severity, and aggravated by physical activity. The headache and associated symptoms of migraine with aura are similar to those of migraine without aura. In contrast to a transient ischemic attack (TIA), the aura of migraine evolves gradually and consists of both positive and negative features. Familial Hemiplegic Migraine (FHM) is an autosomal dominant, genetically heterogenous form of migraine with aura with variable penetration.
Stroke and TIA
Anita Sharma, Shauna Dixon, Tanya Claridge in Maximising Quality and Outcomes Framework Quality Points, 2017
Stroke is the leading cause of disability in the United Kingdom and the third leading cause of death in most Western countries. Patients who have had a transient ischaemic attack (TIA) have a two-day stroke risk of approximately 4%, a seven-day stroke risk of approximately 5.5%, a 30-day stroke risk of approximately 7.5% and a 90-day stroke risk of approximately 9%. The majority of TIAs resolve within one hour and episodes of transient monocular blindness commonly last less than five minutes. A TIA lasting several hours could be due to a complete cerebral infarction or a small cerebral haemorrhage. If a patient is outside the surgery or ringing for an appointment with symptoms suggestive of TIA, a validated fast alcohol screen test tool should be used. The percentage of patients with stroke or TIA who have a record of blood pressure in the notes in the preceding 15 months.
Commonly asked questions in transient ischemic attack
Published in Expert Review of Neurotherapeutics, 2013
Farrukh Chaudhry, José Biller, Murray Flaster
With the advent of modern neuroimaging techniques, transient ischemic attack (TIA) has been redefined as, “a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia, without acute infarction.” If infarct is evident on neuroimaging, the event is a stroke. It is important to recognize and correctly diagnose TIA and minor stroke because of the substantial early risk of stroke. Much of the early stroke risk is attributable to large artery atherosclerosis. Stroke-risk stratification in TIA patients can be done based on clinical grounds using an ABCD2 score. There is, however, abundant data to support inclusion of neuroimaging in stroke-risk determination, which can also be combined with a clinical risk assessment. The hybrid ABCDE⊕ score further refines early stroke risk. Rapid assessment and treatment in the emergency department or in specially designed ‘TIA clinics’ appear to reduce stroke rate.
Spontaneous extracranial arterial dissections in a case of patient with osteogenesis imperfecta
Published in International Journal of Neuroscience, 2021
XiaoJia Tang, Jing Jian, YuHan Luo, Hongyang Fan, PeiPei Liu, YingZhu Chen
Background: Osteogenesis imperfecta (OI), also known as brittle bone disease, is an inherited disease characterized by increased bone brittleness and decreased bone mass. OI patients may also be associated with exoskeleton manifestations such as hearing loss, articular ligament laxity, and heart valve lesions. Reports of internal carotid and cerebral artery dissection related to OI patients are very rare. We present the first case of acute cerebral infarction caused by the progressive stripping of the carotid artery dissection Chinese patient with Osteogenesis imperfecta. Case: A 48-year-old Chinese male who had no prior medical history or bad habits was to admitted the hospital due to leftside temporal headache, paroxysmal right limb weakness, and prolonged blurred vision experienced for a week. After a series of tests were performed to exclude superficial temporal arteritis, the patient was diagnosed with transient ischemic attack and was given aspirin, clopidogrel and atorvastatin without further headache and blurred vision. However, he was again admitted to the emergency department the following day due to right limb weakness for 7 h that was considered acute cerebral infarction caused by left carotid artery dissection. Conclusion: The findings in this case support that internal carotid and cerebral artery dissection may be one of the complications of Osteogenesis imperfecta.
Management of transient ischemic attack: 2005
Published in Expert Review of Cardiovascular Therapy, 2005
Brian Clarke, Allan Moore, Ciaran Donegan
Transient ischemic attack is a common presenting problem to clinicians. Historically, these events were defined by the resolution of new neurologic symptoms within a 24-h time-frame; however, recent data suggests that a 1-h time frame is more appropriate. New imaging techniques and clinical evidence suggests that transient ischemic attacks present a higher risk of impending stroke than previously thought. This has led to a redefinition of what constitutes an attack, and also to a focus on both earlier investigation and treatment of correctable causes. New antiplatelet agents are now available and pose a challenge as to how they should be prescribed. Carotid endarterectomy is the standard of care for a subset of transient ischemic attack patients with significant carotid stenosis. Carotid angioplasty and stenting are more recent developments that may further expand treatment options.
Related Knowledge Centers
- Brain Hypoxia
- Brain Infarction
- Brain Ischemia
- Infarction
- Ischemia
- Spinal Cord
- Retinal Artery Occlusion