temporary (<24 hours) loss of neuro function secondary to vascular
occlusion, duration (majority < 1 hour, carotid - 15 minutes,
vertebral - 10 minutes), increased risk of coronary artery disease,
age > 60, whites > african americans.
Clinical - Can be very subtle with
fluctuating intensity, slurred speech, difficulty swallowing, altered
mental status - memory - behavior - vision (double vision, blindness,
decreased fields) - gait - coordination - reflexes, ataxia, facial
weakness, extremity weakness or paresthesias.
Risk factors - HTN, atherosclerotic
- thromboembolic (AFib, previous MI, mural thrombus...) disease,
previous TIAs - MI - CVAs, arteritis, vasculitis, hypercoaguable
or clotting disorders, arrhythmias, trauma (associated with dissection
of carotid or verterbral arteries), crack - cocaine.
Differential - CVA (evolving, in progress),
hypoglycemia, dementia, SAH, migraine, CNS neoplasm, multiple sclerosis,
Guillain Barre syndrome, myasthenia gravis, acute MI, syncope or
near syncope, vertigo, seizure.
Labs - CBC, PT/PTT, lytes, glucose,
BUN, creatinine, head CT, MRI, MRA, carotid - vertebral - transcranial
ultrasound - doppler, angiography, ECG.
Rx considerations - ASA, Persantine,
Ticlodipine, Coumadin, Heparin, CEA.