transient ischemic attack case presentation ppt

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Chapter 7:  10 Real Cases on Transient Ischemic Attack and Stroke: Diagnosis, Management, and Follow-Up

Jeirym Miranda; Fareeha S. Alavi; Muhammad Saad

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Case 1: Management of Acute Thrombotic Cerebrovascular Accident Post Recombinant Tissue Plasminogen Activator Therapy

A 59-year-old Hispanic man presented with right upper and lower extremity weakness, associated with facial drop and slurred speech starting 2 hours before the presentation. He denied visual disturbance, headache, chest pain, palpitations, dyspnea, dysphagia, fever, dizziness, loss of consciousness, bowel or urinary incontinence, or trauma. His medical history was significant for uncontrolled type 2 diabetes mellitus, hypertension, hyperlipidemia, and benign prostatic hypertrophy. Social history included cigarette smoking (1 pack per day for 20 years) and alcohol intake of 3 to 4 beers daily. Family history was not significant, and he did not remember his medications. In the emergency department, his vital signs were stable. His physical examination was remarkable for right-sided facial droop, dysarthria, and right-sided hemiplegia. The rest of the examination findings were insignificant. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. The neurology team was consulted, and intravenous recombinant tissue plasminogen activator (t-PA) was administered along with high-intensity statin therapy. The patient was admitted to the intensive care unit where his hemodynamics were monitored for 24 hours and later transferred to the telemetry unit. MRI of the head revealed an acute 1.7-cm infarct of the left periventricular white matter and posterior left basal ganglia. How would you manage this case?

This case scenario presents a patient with acute ischemic cerebrovascular accident (CVA) requiring intravenous t-PA. Diagnosis was based on clinical neurologic symptoms and an NIHSS score of 7 and was later confirmed by neuroimaging. He had multiple comorbidities, including hypertension, diabetes, dyslipidemia, and smoking history, which put him at a higher risk for developing cardiovascular disease. Because his symptoms started within 4.5 hours of presentation, he was deemed to be a candidate for thrombolytics. The eligibility time line is estimated either by self-report or last witness of baseline status.

Ischemic strokes are caused by an obstruction of a blood vessel, which irrigates the brain mainly secondary to the development of atherosclerotic changes, leading to cerebral thrombosis and embolism. Diagnosis is made based on presenting symptoms and CT/MRI of the head, and the treatment is focused on cerebral reperfusion based on eligibility criteria and timing of presentation.

Symptoms include alteration of sensorium, numbness, decreased motor strength, facial drop, dysarthria, ataxia, visual disturbance, dizziness, and headache.

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Transient Ischemic Attack

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Transient Ischemic Attack (TIA): Symptoms, Causes, and More

Jul 30, 2022

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A stroke is an injury to the brain that happens when blood flow to the brain is disrupted. The tissue starts to die without blood delivering oxygen to the brain and the functions that are managed by those brain cells, such as speaking and muscle control, become defective. There are two classes of stroke, ischemic, and hemorrhagic. u201cNearly all strokes are ischemic and are caused by a blood clot blocking an artery leading to the brainu201d, shares, Dr. Sujay Shad, the Best Cardiac Surgeon in India at Sir Ganga Ram Hospital, Rajinder Nagar, Delhi. The other class of stroke is hemorrhagic. This type o

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Transient Ischemic Attack (TIA): Symptoms, Causes, and More A stroke is an injury to the brain that happens when blood flow to the brain is disrupted. The tissue starts to die without blood delivering oxygen to the brain and the functions that are managed by those brain cells, such as speaking and muscle control, become defective. There are two classes of stroke, ischemic, and hemorrhagic. “Nearly all strokes are ischemic and are caused by a blood clot blocking an artery leading to the brain”, shares, Dr. Sujay Shad, the Best Cardiac Surgeon in India at Sir Ganga Ram Hospital, Rajinder Nagar, Delhi. The other class of stroke is hemorrhagic. This type of stroke is brought on when a blood vessel in the brain splits or breaks, leading to bleeding which damages the surrounding brain tissue. TIA Is Similar To A Stroke A Mini Stroke or Transient ischemic attack (TIA) is an event that occurs when blood flow stops to a part of the brain for a short time. TIA is similar to a stroke and causes the same symptoms, but usually lasts minutes to hours and does not cause damage to the brain. Healthcare providers assess a patient’s overall picture, in addition to the span of symptoms, and perform an MRI to check if the patient had a TIA or a stroke. A TIA begins the same as an ischemic stroke. The cause and symptoms of TIA and stroke are the same. However, in TIA, the stoppage is short-term and blood flow returns naturally on its own. Symptoms of a TIA resolve and normal function returns in minutes to hours. The medical prognosis for TIA is good since blood flow rectifies, causing no damage to brain cells. In reverse, the recovery and prognosis for a stroke differs. This is because blood flow does not resolve, and brain cells are damaged permanently. Immediate treatment may increase recovery and improve medical prognosis, but the symptoms of stroke may be long-lasting and never completely resolve. Recovery from stroke may last for an elongated time and require continuing therapy.

The National Stroke Association and other organizations suggest using the phrase BE-FAST as a simplified way to find out if someone is having a stroke or TIA and what to do. B - Balance. Are they having a hard time staying upright and sturdy on their feet? E - Eyes. Look over for eyesight loss. F - Face. Ask the person to smile; if one side of the face droops, it is a warning sign. A - Arms. Ask the person to raise both arms; if one arm has difficulty moving, it is a warning sign. S - Speech. Ask the person to speak something; if the speech is mumbled, it is a warning sign. T - Time. If a person develops any of the warning signs, it is time to consult a doctor immediately. Other symptoms of a TIA may include the following: ● Numbness in the face, arm, or leg, usually only on one side of the body ● Difficulty in speaking ● Tingling sensation ● Confusion ● Loss of balance. TIAs are an early threatening sign that a person is at risk of stroke, so the symptoms should not be neglected. The risk of stroke is especially high within 48 hours after a TIA. Since the symptoms of stroke and TIA are the same, an individual should look for medical attention immediately even if the symptoms go away. Risks of TIA and stroke include: ● The risk of stroke doubles with each decade after the age of 55 in both men and women. ● Family history of stroke ● Hypertension ● Diabetes ● Heart disease ● Atrial fibrillation

● Smoking (both tobacco and marijuana) ● High blood cholesterol levels ● Drug addiction ● Overweight One must follow the following tips to reduce the risk of future TIAs or strokes: ● Quit smoking. ● Keep an eye on your blood pressure and follow the doctor’s treatment plan if blood pressure is high. ● Observe your cholesterol levels and follow the doctor’s treatment plan if your cholesterol level is high. The target low density lipoprotein (LDL) level is less than 100 mg/dl in patients with stroke or TIA and lower than 70 mg/dl in patients who also have diabetes. ● Eat a diet high in vegetables, fruits, fish, legumes, poultry, nuts, and low-fat dairy products. ● Exercise. Participate in 3 to 4, 40-minute sessions of moderate to intense aerobic exercise per week. ● Wear Continuous Positive Airway Pressure (CPAP) device if diagnosed with sleep apnea and the doctor recommends use of this device. If anyone is, experiencing any type of concern related to the heart and associated organs they can consult Dr. Sujay Shad, best Heart Surgery Doctor in India. He specializes in performing lifesaving heart surgeries like Heart Transplants, Coronary Bypasses, HOCM, Aortic Surgery, and Mitral Valve at Best Hospital for Heart Surgery in India, Sir Ganga Ram Hospital, located at Rajinder Nagar, Delhi.

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Chapter 7:  10 Real Cases on Transient Ischemic Attack and Stroke: Diagnosis, Management, and Follow-Up

Jeirym Miranda; Fareeha S. Alavi; Muhammad Saad

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Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

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Case review, case discussion, clinical symptoms.

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Case 1: Management of Acute Thrombotic Cerebrovascular Accident Post Recombinant Tissue Plasminogen Activator Therapy

A 59-year-old Hispanic man presented with right upper and lower extremity weakness, associated with facial drop and slurred speech starting 2 hours before the presentation. He denied visual disturbance, headache, chest pain, palpitations, dyspnea, dysphagia, fever, dizziness, loss of consciousness, bowel or urinary incontinence, or trauma. His medical history was significant for uncontrolled type 2 diabetes mellitus, hypertension, hyperlipidemia, and benign prostatic hypertrophy. Social history included cigarette smoking (1 pack per day for 20 years) and alcohol intake of 3 to 4 beers daily. Family history was not significant, and he did not remember his medications. In the emergency department, his vital signs were stable. His physical examination was remarkable for right-sided facial droop, dysarthria, and right-sided hemiplegia. The rest of the examination findings were insignificant. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. The neurology team was consulted, and intravenous recombinant tissue plasminogen activator (t-PA) was administered along with high-intensity statin therapy. The patient was admitted to the intensive care unit where his hemodynamics were monitored for 24 hours and later transferred to the telemetry unit. MRI of the head revealed an acute 1.7-cm infarct of the left periventricular white matter and posterior left basal ganglia. How would you manage this case?

This case scenario presents a patient with acute ischemic cerebrovascular accident (CVA) requiring intravenous t-PA. Diagnosis was based on clinical neurologic symptoms and an NIHSS score of 7 and was later confirmed by neuroimaging. He had multiple comorbidities, including hypertension, diabetes, dyslipidemia, and smoking history, which put him at a higher risk for developing cardiovascular disease. Because his symptoms started within 4.5 hours of presentation, he was deemed to be a candidate for thrombolytics. The eligibility time line is estimated either by self-report or last witness of baseline status.

Ischemic strokes are caused by an obstruction of a blood vessel, which irrigates the brain mainly secondary to the development of atherosclerotic changes, leading to cerebral thrombosis and embolism. Diagnosis is made based on presenting symptoms and CT/MRI of the head, and the treatment is focused on cerebral reperfusion based on eligibility criteria and timing of presentation.

Symptoms include alteration of sensorium, numbness, decreased motor strength, facial drop, dysarthria, ataxia, visual disturbance, dizziness, and headache.

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Transient Ischemic Attack PowerPoint Presentation – Medical PPT

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As a part of our Medical PowerPoint Presentations we are enlisting the most searched and most ongoing health issue i.e Stroke. There many kinds of strokes and we will be adding one by one at a time. But for today we are listing the TIA or Transient Ischemic Attack PowerPoint Presentation, a simple 10 slides presentation that contains the basic information on the Ischemic stroke.

The best part is that you can add your own creative content and make it even more appealing to your audience. In this presentation We have tried to maintain a tone to keep your audience focused. The fonts used in this presentation are compatible with any operating system, and the elements used are PowerPoint native shapes which means you can edit them as required. This presentation also has animations applied, you can enable/disable as you like.

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Ischemic Stroke Clinical Case

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An ischemic stroke is what happens when one of the vessels that supply the brain gets obstructed, and it can cause serious damage to the brain. In order to identify when something like this might be happening to us, we must go FAST. This doesn’t mean that we should rush, FAST is the acronym of Face dropping, Arm weakness, Speech difficulty and Time to call 911. Those are the things you need to identify as soon as possible to lessen the effects of a stroke. Are you aware of techniques like this one? Or maybe you have developed a new treatment for people affected? With this template that combines red and white you can explain it all in detail! The information will be crystal clear thanks to the different resources we have included to help you give medical data: graphs, maps, charts… Everything is editable, so you can adapt the presentation to your needs. Download it now and start preparing a presentation that will save lifes!

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Introduction, case report, acknowledgements, conflict of interest statement, ethical approval, ‘crescendo transient ischemic attack’—an uncommon presentation of a very common disease: a case report on capsular warning syndrome.

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Alvin Oliver Payus, Azliza Ibrahim, Vinushini Chandra Sheaker, Wan Nur Nafisah Wan Yahya, ‘Crescendo transient ischemic attack’—an uncommon presentation of a very common disease: a case report on capsular warning syndrome, Oxford Medical Case Reports , Volume 2022, Issue 1, January 2022, omab129, https://doi.org/10.1093/omcr/omab129

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Capsular warning syndrome is a rare presentation of transient ischaemic attack, which described as recurrent episodes of motor and/or sensory deficits which typically sparring the cortical function. It has a significant risk to progress into a massive stroke with permanent disability, thus important to be recognise early. Here, we report a middle-age gentleman with no known medical illness presented with eight episodes of transient ischaemic attack within the span of 24 h. He was treated with double anti-platelet for 21 days and was not subjected to thrombolysis at time of presentation because it was outside the window period of 4.5 h, and has fully recovered after each episode. The purpose of this case report is to share the uncommon clinical presentation of transient ischaemic attack, which is still not fully understood and warrant more studies especially on the treatment that can affect the progression of the disease.

Capsular warning syndrome (CWS) was first described in 1993 by Donnan et al. [ 1 ] as recurrent episodes of transient ischaemic attacks (TIA) which predominantly involve the internal capsule, presenting with motor and/or sensory deficits and sparing the cortical function.

Although this syndrome is rare and only reported in <5% of all cases of TIA, but it has a high risk of developing imminent stroke [ 2 ]. The pathophysiological mechanism of symptoms fluctuation in this syndrome is still not yet fully understood. As this syndrome is rare, there is still no consensus on the treatment that will modify the disease progression.

A 62-year-old gentleman with no known medical illness presented to the emergency department with recurrent episode of left sided body weakness for the past 12 h. He described that each episode lasted for 15–30 min before recovery and was associated with difficulty to stand and walk during the weakness. He suffered about six episodes prior to admission and another two episodes while he was in the emergency department. He claims that each episode will follow a full recovery. He has no preceding head injury, no fever, no loss of consciousness, no visual disturbance and no slurring of speech. On further history, he is not taking any regular prescribed or over the counter medications, and never take any traditional or anti-aggregation medication. There was no similar condition occur in the family. He is a chronic cigarette smoker who smoke one pack year cigarette for the past 40 years, and do not drink alcohol. He works as a constructional contractor in his own company. Upon arrival to the emergency department, he was alert, conscious and fully orientated to time, place and person. His blood pressure was 180/100 mm Hg, pulse rate was 100 bpm, and it was regular rhythm with normal volume, respiratory rate was 20 bpm and he was afebrile. On physical examination, the muscle power for both upper and lower limb was full, there was no sensory abnormality, no ataxia and his cranial nerve was intact. Examination of the cardiorespiratory system reveal no abnormality, and his abdomen was soft, not tender and there were no palpable organomegaly nor mass noted. Initial blood investigations were taken and shows normal cell counts, renal and liver function, lipid profile and fasting blood glucose. There was no electrolyte abnormality noted (as shown in Table 1 ). Plain computed tomography (CT) scan of the brain shows no intracranial bleeding nor any infarction. While waiting for admission in the emergency department, he developed another two episodes of transient left sided hemiparesis which lasted for 15 min. Urgent CT angiography of the brain was done and shows small well defined hypodensities at the body of right caudate nucleus. The major intracranial arteries have normal calibre and there is no filling defect to suggest thrombosis over the vertebrobasilar arteries (as shown in Fig. 1 ). He was started on dual oral anti-platelet (aspirin 300 mg loading dose then 150 mg daily, and clopidogrel 300 mg loading dose then 75 mg daily thereafter). The clopidogrel was plan for 21 days only, and then he will continue with single anti-platelet thereafter for life. He was also started on oral atorvastatin 40 mg once every night, and oral perindopril 4 mg daily. He was discharge after no further episode of transient hemiparesis for 48 h observation in the ward. He was schedule for magnetic resonance imaging of the brain later to assess the brainstem. Upon follow-up via teleconsultation after 3 months, the patient is well with no residual weakness. He continues to take his oral aspirin 150 mg daily, oral atorvastatin 40 mg once every night and oral perindopril 4 mg daily.

Initial blood investigation upon admission shows normal blood cells count, renal profile and liver function, no electrolyte abnormality, normal lipid profile and fasting blood glucose

Computed tomographic angiography of the brain shows small well defined hypodensities at the body of right caudate nucleus. The major intracranial arteries have normal calibre and there is no filling defect to suggest thrombosis over the vertebrobasilar arteries.

CWS is a term to coined multiple episodes of stereotyped TIA which usually occur in the proximity of each other in time.

It was first described by Donnan et al. in 1993 [ 1 ] as a recurrent episode of motor or sensory, or both sensorimotor deficits in the absence of cortical symptoms. CWS is rare, where the incidence was only 1.5%–4.5% of TIA. However, it is particularly important because it has a high risk of developing massive ischaemic stroke with a permanent neurological deficit. According to a report from a population study, the 7-day stroke risk following a CWS is as high as 60% [ 2 ]. The classical clinical presentations of CWS are unilateral pure motor or sensory or sensorimotor deficits that involve at least two of the three (face, arm or leg). CWS characteristically do not have any cortical signs [ 1 ]. This is because CWS commonly affect the internal capsule area [ 3 ], or in some cases, the pons, midbrain and thalamus [ 3 , 4 ].

The exact pathophysiological mechanism of CWS is still remain unknown. There were studies that relate co-morbidities with hypertension, diabetes, dyslipidaemia, cigarette smoking and other stroke risk factors to developing CWS, which suggest that atherosclerosis of the small-penetrating arteries may be involved in the pathogenesis [ 4 , 5 ]. There was also some speculation that CWS was associated with small-penetrating arterial disease where intermittent hemodynamic changes due to structural arterial changes or hypertension leading to ischaemia [ 4 ]. However, the reasons behind fluctuations of symptoms are still yet to be discover.

Up to date, there is still no consensus on the definite treatment for CWS. Intravenous (IV) thrombolysis, oral anti-platelet therapy whether double or single, oral anticoagulants and some less common like vasopressors have been used to treat CWS patient. It has been an ongoing debate whether CWS should undergo thrombolysis or not. Some studies shown thrombolysis was effective in making the symptoms disappear [ 6 , 7 ], whereas other studies showed there was no significant different in functional outcome between CWS patient that undergone thrombolysis and those who did not [ 4 ]. However, IV thrombolysis has been safe for CWS patients, and there was no bleeding complication have been reported. Therefore, the author believes IV thrombolysis is an alternative treatment for CWS patient that has a prolonged clinical event and present within the therapeutic window of 4.5 h after the onset of symptoms.

Our patient presented with a CWS symptoms and was treated with double anti-platelet. He did not fulfil the criteria for thrombolysis because he presented outside the window period of 4.5 h, and his symptoms was mild and short lived before complete recovery. Immediate plain CT scan of the brain was normal, but CT angiography of the brain later confirm that there is an acute infarction over the internal capsule that correlate with the clinical presentation.

In conclusion, capsular warning syndrome is a rare spectrum of transient ischaemic attack which has high tendency to develop a full-blown stroke. There is still no general consensus on the treatment options of the condition. Therefore, further research that focused on the treatment that will alter the disease progression should be made.

The authors would like to thank the patient for giving his consent and cooperation in relation to the writing of this case report. The author would also like to thank the Director General of Ministry of Health of Malaysia for his permission to publish this article. There is no financial support for this publication.

None declared.

Consent from the patient was taken for the writing and publication of this case report.

No ethical approval is required for case report in our centre.

Alvin Oliver Payus.

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