Transient Ischemic Attack (TIA)

Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. A “tissue-based” definition is currently used rather than the former time-based limit of symptoms lasting less than 24 hours. The causes of TIA may be small clots or thromboemboli imposed on a blood vessel compromised by atherosclerosis Atherosclerosis Atherosclerosis is a common form of arterial disease in which lipid deposition forms a plaque in the blood vessel walls. Atherosclerosis is an incurable disease, for which there are clearly defined risk factors that often can be reduced through a change in lifestyle and behavior of the patient. Atherosclerosis, inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation, or amyloid; inadequate cerebral blood flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure from vasoconstriction; or severe hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension. The clinical presentation includes transient neurologic deficits that resolve spontaneously. Management includes the reduction of risk factors to decrease the risk of a future stroke.

Last update:

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

Share this concept:

Share on facebook
Share on twitter
Share on linkedin
Share on reddit
Share on email
Share on whatsapp

Overview

Definition

A transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored.

Epidemiology

  • Difficult to determine due to other mimicking disorders
  • Incidence: approximately 500,000 cases per year in the US
  • The estimated overall prevalence of TIA in the US is 2%.

Etiology

  • Thrombosis with rupture of atherosclerotic plaques
  • Emboli from cardiac sources:
    • Left atrial thrombi/ atrial fibrillation Atrial fibrillation Atrial fibrillation (AF or Afib) is a supraventricular tachyarrhythmia and the most common kind of arrhythmia. It is caused by rapid, uncontrolled atrial contractions and uncoordinated ventricular responses. Atrial Fibrillation
    • Left ventricular thrombi
    • Rheumatic mitral or aortic valve disease
    • Bioprosthetic and mechanical heart valve emboli
    • Carotid atherosclerosis Atherosclerosis Atherosclerosis is a common form of arterial disease in which lipid deposition forms a plaque in the blood vessel walls. Atherosclerosis is an incurable disease, for which there are clearly defined risk factors that often can be reduced through a change in lifestyle and behavior of the patient. Atherosclerosis
    • Bacterial endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis (septic emboli)
    • Patent foramen ovale Patent Foramen Ovale A patent foramen ovale (PFO) is an abnormal communication between the atria that persists after birth. The condition results from incomplete closure of the foramen ovale. Small, isolated, and asymptomatic PFOs are a common incidental finding on echocardiography and require no treatment. Patent Foramen Ovale
    • Arterial dissection (rupture of an arterial wall followed by thrombus formation and embolization)
  • Atherosclerosis may also be embolic (in addition to thrombotic):
    • Iatrogenic embolization after an angiogram or other vascular procedures
    • Emboli released during carotid artery surgery

Risk factors

  • Hypertension Hypertension Hypertension, or high blood pressure, is a common disease that manifests as elevated systemic arterial pressures. Hypertension is most often asymptomatic and is found incidentally as part of a routine physical examination or during triage for an unrelated medical encounter. Hypertension (most important)
  • Previous history of TIA
  • Diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Smoking
  • Hyperlipidemia
  • Atrial fibrillation
  • Carotid stenosis or other arterial stenoses
  • Patent foramen ovale Patent Foramen Ovale A patent foramen ovale (PFO) is an abnormal communication between the atria that persists after birth. The condition results from incomplete closure of the foramen ovale. Small, isolated, and asymptomatic PFOs are a common incidental finding on echocardiography and require no treatment. Patent Foramen Ovale

Pathophysiology and Clinical Presentation

The presentation depends on the pathophysiologic mechanism: embolic, lacunar (small penetrating vessel) TIA, or large artery TIA.

Pathophysiology

  • Temporary occlusion of a blood vessel (due to a small thrombus, embolus, vasoconstriction, or systemic hypoperfusion) to the brain, spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord, or retina →
  • Reduction in blood flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure to the region supplied by the vessels →
  • Cerebral or other tissues undergo ischemia →
  • Neurons are deprived of glucose and oxygen → failure of mitochondria to produce ATP
  • Minutes to hours later, before infarction occurs, blood flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure is restored and all neurologic dysfunction resolves.

Clinical presentation

The affected individual may not recall the time of onset of neurological symptoms. Establish a precise account of the event, if possible, from family members or caregivers, and include the time of onset and resolution, if the symptoms have already improved.

Symptoms of TIA relate to the vascular territory that is being compromised:

  • Internal carotid artery and middle cerebral artery (MCA) symptoms:
    • Transient monocular blindness (amaurosis fugax) or hemianopia
    • Motor weakness in the arm Arm The arm, or "upper arm" in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm/ hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand > leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg > face
    • Milder sensory loss in the same areas
    • Aphasia and alexia (inability to interpret written language)
  • Vertebral artery/basilar artery symptoms:
    • Quadriparesis
    • Crossed motor weakness and sensory abnormalities (1 side of the cranial nerve distribution with the opposite side limbs and the trunk)
    • Gait ataxia
    • Brainstem and cranial nerve symptoms: dizziness, diplopia, tinnitus
  • Posterior cerebral artery (PCA):
    • Hemianopia/blindness
    • Hemisensory loss in the arm Arm The arm, or "upper arm" in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm/ hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand > leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg or face
    • Amnesia
    • Alexia
  • Lacunar infarcts:
    • Hemiparesis
    • Hemisensory loss in the face > arm Arm The arm, or "upper arm" in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm or leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg
    • Limb ataxia/weakness
    • Mild dysarthria and dysphagia Dysphagia Dysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming "stuck." Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical. Dysphagia
  • Atypical TIA symptoms:
    • Gradual increase in symptoms over > 5 minutes
    • Progression of symptoms from 1 body part to another
    • Isolated visual disturbances (e.g., flashing lights)
    • Isolated sensory symptoms (e.g., in a finger or the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue)
    • Isolated brainstem symptoms (e.g., dysarthria, diplopia, or hearing loss Hearing loss Hearing loss, also known as hearing impairment, is any degree of impairment in the ability to apprehend sound as determined by audiometry to be below normal hearing thresholds. Clinical presentation may occur at birth or as a gradual loss of hearing with age, including a short-term or sudden loss at any point. Hearing Loss)

Diagnosis

Since the etiologies for stroke and TIA are very similar, the diagnostic evaluation for TIA resembles that for ischemic stroke Ischemic Stroke An ischemic stroke (also known as cerebrovascular accident) is an acute neurologic injury that occurs as a result of brain ischemia; this condition may be due to cerebral blood vessel occlusion by thrombosis or embolism, or rarely due to systemic hypoperfusion. Ischemic Stroke.

  • History as above; always ask about:
    • Past episodes of TIA
    • Medications
    • Cardiovascular risk factors
    • Prior carotid or heart surgeries
  • Physical examination:
    • Neurologic symptoms may have been resolved by the time the affected individual arrives at the ED.
    • Vital signs and simultaneous point-of-care glucose
    • General exam including cardiac exam
    • Detailed neurological exam as much as feasible:
      • Signs and symptoms depend on the vascular territory affected.
      • Affected individuals may exhibit some degree of memory loss or amnesia of the events.
  • Labs:
    • CBC including platelet count
    • Chemistry: electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various basic life-sustaining functions. Electrolytes, glucose, BUN, and creatinine
    • Serum lipid profile provides a baseline but may not be accurate in an acute emergency situation.
    • PT and PTT
    • Cardiac enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body's constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes
    • Direct factor Xa activity assay: if the affected individual is taking a direct thrombin inhibitor or direct factor Xa inhibitor and is a candidate for thrombolytic therapy
    • Urinalysis
  • Other tests: ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Normal Electrocardiogram (ECG) for arrhythmia or ischemic changes
  • Imaging:
    • Noncontrast head CT:
      • Only for differentiation between ischemic and hemorrhagic strokes
      • Acute ischemic zones are NOT visualized (can be mistaken for a normal scan).
      • Preferred emergency imaging modality
    • MRI brain:
      • Allows visualization of acute ischemia and ischemic penumbra = greater sensitivity
      • Better resolution but longer time for imaging
      • Less availability
    • Carotid ultrasonography or transcranial Doppler ultrasonography: to evaluate for atherosclerotic stenosis or aneurysms
    • Echocardiogram/transesophageal echocardiogram: to detect structural abnormalities that could facilitate embolization
      • Patent foramen ovale Patent Foramen Ovale A patent foramen ovale (PFO) is an abnormal communication between the atria that persists after birth. The condition results from incomplete closure of the foramen ovale. Small, isolated, and asymptomatic PFOs are a common incidental finding on echocardiography and require no treatment. Patent Foramen Ovale
      • Atrial septal defect Atrial Septal Defect Atrial septal defects (ASDs) are benign acyanotic congenital heart defects characterized by an opening in the interatrial septum that causes blood to flow from the left atrium (LA) to the right atrium (RA) (left-to-right shunt). Atrial Septal Defect
      • Clots in the atria or ventricles
Axial cut of a ct scan of a patient with acute ischemic stroke

Axial cut of a CT scan of an individual with acute ischemic stroke Ischemic Stroke An ischemic stroke (also known as cerebrovascular accident) is an acute neurologic injury that occurs as a result of brain ischemia; this condition may be due to cerebral blood vessel occlusion by thrombosis or embolism, or rarely due to systemic hypoperfusion. Ischemic Stroke performed at the time of admission:
Note the lack of discernible changes.

Image: “Pseudoradial Nerve Palsy Caused by Acute Ischemic Stroke” by Tahir H, Daruwalla V, Meisel J, Kodsi SE. License: CC BY 3.0

Management

Initial management

  • Assess the individual’s airway, breathing, and circulation (ABC).
  • Treat hypoglycemia Hypoglycemia Hypoglycemia is an emergency condition defined as a serum glucose level ≤ 70 mg/dL (≤ 3.9 mmol/L) in diabetic patients. In nondiabetic patients, there is no specific or defined limit for normal serum glucose levels, and hypoglycemia is defined mainly by its clinical features. Hypoglycemia or hyperglycemia accordingly (may mimic TIA or stroke).
  • IV fluids IV fluids Intravenous fluids are one of the most common interventions administered in medicine to approximate physiologic bodily fluids. Intravenous fluids are divided into 2 categories: crystalloid and colloid solutions. Intravenous fluids have a wide variety of indications, including intravascular volume expansion, electrolyte manipulation, and maintenance fluids. Intravenous Fluids
  • ABCD2 score = stroke risk stratification
    • Predicts stroke risk in the next 2 days, 7 days, and 90 days
    • Consider hospitalization if the score is ≥ 4.
    • Age ≥ 60 years
    • Blood pressure (initial): higher risk of stroke if systolic blood pressure ≥ 140 or diastolic blood pressure ≥ 90
    • Clinical features of TIA:
      • Unilateral weakness
      • Speech disturbance without weakness
    • Duration of symptoms
    • Diabetes history
  • Consider thrombolytic therapy if TIA evolves to a diagnosis of stroke.

Prevention of future TIAs and stroke

  • Lifestyle changes:
    • Healthy diet (e.g., Mediterranean diet)
    • Exercise as tolerated, consider weight loss if obese
    • Smoking cessation counseling, if applicable
  • Risk-factor management with improved control of:
    • Diabetes
    • Hypertension Hypertension Hypertension, or high blood pressure, is a common disease that manifests as elevated systemic arterial pressures. Hypertension is most often asymptomatic and is found incidentally as part of a routine physical examination or during triage for an unrelated medical encounter. Hypertension
    • Hyperlipidemia
  • Medications:
    • Antiplatelet therapy unless contraindicated:
      • Aspirin
      • Clopidogrel or extended-release dipyridamole if unable to take aspirin
    • Statins Statins Statins are competitive inhibitors of HMG-CoA reductase in the liver. HMG-CoA reductase is the rate-limiting step in cholesterol synthesis. Inhibition results in lowered intrahepatocytic cholesterol formation, resulting in up-regulation of LDL receptors and, ultimately, lowering levels of serum LDL and triglycerides. Statins (e.g., atorvastatin) in clinically important atherosclerotic disease
    • Anticoagulants Anticoagulants Anticoagulants are drugs that retard or interrupt the coagulation cascade. The primary classes of available anticoagulants include heparins, vitamin K-dependent antagonists (e.g., warfarin), direct thrombin inhibitors, and factor Xa inhibitors. Anticoagulants, if indicated for atrial fibrillation Atrial fibrillation Atrial fibrillation (AF or Afib) is a supraventricular tachyarrhythmia and the most common kind of arrhythmia. It is caused by rapid, uncontrolled atrial contractions and uncoordinated ventricular responses. Atrial Fibrillation or coagulation disorder
  • Treat the underlying causes.
  • Surgery (carotid endarterectomy):
    • If workup reveals symptomatic internal carotid artery stenosis Carotid artery stenosis Carotid artery stenosis is a chronic atherosclerotic disease resulting in narrowing of the common and internal carotid arteries. Common risk factors include family history, advanced age, hyperlipidemia, smoking, and diabetes mellitus. Patients may present with or without symptoms of decreased cerebral perfusion. Carotid Artery Stenosis > 70%
    • Benefits of surgery must outweigh the risks, which also include stroke.
  • Family and patient education:
    • Continuation of preventive measures at home 
    • The “FAST” mnemonic is helpful for lay individuals to identify the recurrence of TIAs:
      • Facial droop
      • Arm weakness
      • Speech abnormality
      • Time

Prognosis

  • TIA is a prognostic indicator of stroke.
  • 50% risk of stroke within the 1st 2 days after symptom onset
  • 10%–15% risk of stroke in the 1st 3 months
  • 5%–6% annual mortality rate after TIA

Differential Diagnosis

  • Ischemic (or hemorrhagic) stroke ( cerebrovascular accident Cerebrovascular accident An ischemic stroke (also known as cerebrovascular accident) is an acute neurologic injury that occurs as a result of brain ischemia; this condition may be due to cerebral blood vessel occlusion by thrombosis or embolism, or rarely due to systemic hypoperfusion. Ischemic Stroke): an acute neurologic injury resulting from brain ischemia, which may be due to cerebral blood vessel occlusion by thrombosis or embolism. The clinical presentation includes neurologic symptoms with varying degrees of motor and sensory loss. Diagnosis is made by physical examination and imaging. Management is ideally with thrombolytic therapy. Long-term rehabilitation with PT is important after the acute event.
  • Migraine Migraine Migraine headache is a primary headache disorder and is among the most prevalent disorders in the world. Migraine is characterized by episodic, moderate to severe headaches that may be associated with increased sensitivity to light and sound, as well as nausea and/or vomiting. Migraine Headache: a common primary headache disorder characterized by episodic, moderate-to-severe headaches that may be associated with increased sensitivity to light and sound, and nausea and/or vomiting. Migraines with aura may be indistinguishable from TIA due to vasoconstriction, which causes ischemia and neurologic deficits similar to an ischemic stroke Ischemic Stroke An ischemic stroke (also known as cerebrovascular accident) is an acute neurologic injury that occurs as a result of brain ischemia; this condition may be due to cerebral blood vessel occlusion by thrombosis or embolism, or rarely due to systemic hypoperfusion. Ischemic Stroke, including hemiplegia. Diagnosis is based on clinical history, physical exam, and imaging findings. Management includes medications to treat migraines and the avoidance of triggers.
  • Intracranial tumor: can be a primary neoplasm derived from intracranial tissues ( astrocytoma Astrocytoma Astrocytomas are neuroepithelial tumors that arise from astrocytes, which are star-shaped glial cells (supporting tissues of the CNS). Astrocytomas are a type of glioma. There are 4 grades of astrocytomas. Astrocytoma, oligodendroglioma Oligodendroglioma Oligodendrogliomas are malignant CNS tumors arising from neural glial cell precursors. Oligodendrogliomas often arise in the frontal lobes of the brain and have a generally favorable prognosis when compared to other gliomas. Oligodendrogliomas are the 3rd most common CNS tumor. The most frequent presenting symptom is a seizure. Oligodendroglioma, meningioma Meningioma Meningiomas are slow-growing tumors that arise from the meninges of the brain and spinal cord. The vast majority are benign. These tumors commonly occur in individuals with a history of high doses of skull radiation, head trauma, and neurofibromatosis 2. Meningioma) or a metastatic process from another malignancy such as lung or breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer. As the mass grows, it can give rise to neurological symptoms similar to those seen in an ischemic stroke Ischemic Stroke An ischemic stroke (also known as cerebrovascular accident) is an acute neurologic injury that occurs as a result of brain ischemia; this condition may be due to cerebral blood vessel occlusion by thrombosis or embolism, or rarely due to systemic hypoperfusion. Ischemic Stroke. Diagnosis is based on imaging studies and management is based on addressing the underlying cause.
  • Brain abscess Brain abscess Brain abscess is a life-threatening condition that involves the collection of pus in the brain parenchyma caused by infection from bacteria, fungi, parasites, or protozoa. The most common presentation is headache, fever with chills, seizures, and neurological deficits. Brain Abscess: a life-threatening condition involving the collection of pus in the brain parenchyma due to an infection. Brain abscesses may also result from trauma or a surgical complication. The most common presentations include headache, fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever with chills, seizures Seizures A seizure is abnormal electrical activity of the neurons in the cerebral cortex that can manifest in numerous ways depending on the region of the brain affected. Seizures consist of a sudden imbalance that occurs between the excitatory and inhibitory signals in cortical neurons, creating a net excitation. The 2 major classes of seizures are focal and generalized. Seizures, and neurologic deficits. Diagnosis is by MRI and/or CT-guided aspiration of the contents for culture. Management requires surgical drainage and antibiotics.
  • Carotid artery aneurysm Aneurysm An aneurysm is a bulging, weakened area of a blood vessel that causes an abnormal widening of its diameter > 1.5 times the size of the native vessel. Aneurysms occur more often in arteries than in veins and are at risk of dissection and rupture, which can be life-threatening. Extremity and Visceral Aneurysms or dissection: a condition that may occur when the integrity of the arterial walls fails, usually abruptly, resulting in intramural hematoma formation and a false lumen leading to the formation of an aneurysm Aneurysm An aneurysm is a bulging, weakened area of a blood vessel that causes an abnormal widening of its diameter > 1.5 times the size of the native vessel. Aneurysms occur more often in arteries than in veins and are at risk of dissection and rupture, which can be life-threatening. Extremity and Visceral Aneurysms and, later, dissection. Affected individuals typically present with unilateral head or neck pain Neck Pain Neck pain is one of the most common complaints in the general population. Depending on symptom duration, it can be acute, subacute, or chronic. There are many causes of neck pain, including degenerative disease, trauma, rheumatologic disease, and infections. Neck Pain and/or stroke-like symptoms. Dissections are confirmed based on imaging studies and are treated by medical management and, sometimes, surgical management. Complications can include cerebrovascular stroke and death in severe cases.
  • Hypoglycemia: an emergency condition characterized by a drop in glucose levels to < 55 mg/dL (3 mmol/L), although the specific values vary among and within individuals over time. The clinical presentations of hypoglycemia Hypoglycemia Hypoglycemia is an emergency condition defined as a serum glucose level ≤ 70 mg/dL (≤ 3.9 mmol/L) in diabetic patients. In nondiabetic patients, there is no specific or defined limit for normal serum glucose levels, and hypoglycemia is defined mainly by its clinical features. Hypoglycemia include neuroglycopenic symptoms such as dizziness, confusion, lethargy, and loss of consciousness, and can mimic a TIA or stroke. Diagnosis is based on lab testing. Management is with oral glucose or IV dextrose and depends on the severity of symptoms.

References

  1. Panuganti, K.K., Tadi, P., Lui, F. (2021). Transient ischemic attack. StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved August 5, 2021, from http://www.ncbi.nlm.nih.gov/books/NBK459143/ 
  2. Smith, W.S., Johnston, S.C., Hemphill, J., Claude, I. I. I. (2018). Ischemic Stroke. In J.L. Jameson, et al. (Eds.), pp. 3079–3091, Harrison’s Principles of Internal Medicine, 20e. McGraw-Hill Education.
  3. Powers, W.J., et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12), e344–e418. https://doi.org/10.1161/STR.0000000000000211 
  4. Kasner, S. (2021). Stroke and other cerebrovascular diseases. DeckerMed Medicine. Retrieved July 31, 2021, from doi:10.2310/.1027.
  5. Furie, K.L., Rost, N.S. (2021). Definition, etiology, and clinical manifestations of transient ischemic attack. UpToDate. Retrieved August 5, 2021, from https://www.uptodate.com/contents/definition-etiology-and-clinical-manifestations-of-transient-ischemic-attack
  6. Caplan, L.R. (2019). Differential diagnosis of transient ischemic attack and acute stroke. UpToDate. Retrieved August 6, 2021, from https://www.uptodate.com/contents/differential-diagnosis-of-transient-ischemic-attack-and-acute-stroke

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

0.0

()

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details