||FORUM CASE_STUDY : a) TRANSIENT ISCHAEMIC
TRANSIENT ISCHAEMIC ATTACK
Written by Kuganathan V. Ramasamy
A 55-year old gentleman presented in the Accident & Emergency (A&E )department 3 hours after an onset of left upper limb and left lower limb weakness. The weakness developed just after he had his lunch. The patient had a history of diabetes mellitus and hypertension for 3 years with ischaemic heart disease for 5 years. The patient also presented with slurring of speech with no dysphasia. He had left facial deviation with numbness. However, he did not have dizziness, double vision, nausea, vomiting, chest pain or difficulty in breathing..
On examination, the patient was alert, conscious, and afebrile. Blood pressure was 120/100mmHg.There was increased tone and reflexes in the left upper and lower limbs. The power in the left upper and lower limbs was 1/5. Plantar was up going in the left leg. CT scan of brain was done urgently to confirm diagnosis and differentiate between ischaemic and haemorrhagic stroke.ECG showed old Q waves in inferior leads. Eight hours after the onset of weakness, powering the left side of body improved to 5/5 and the patient had no facial deviation. A diagnosis of transient ischemic attack was made (neurological deficit lasting less than 24 hours).The patient was very happy when he recovered from the weakness.
Transient Ischaemic Attack is common in Malaysia. The risk factors were diabetes mellitus and hypertension.The treatment given was aspirin and aspirin. He was continued with medications for DM and hypertension. Furthermore, the patient also had been advised diet control and compliance to medication. The important role as a clinician here is identification of the disease and prevention of stroke. There is ABCD2 score which assesses the risk of transient ischaemic attack to stroke.
|Stroke Prevention: Recommendations. Research Findings for Clinicians. Fact sheet.
|Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/clinic/strokcln.htm