Evaluation of TIA Symptoms and Diagnostic Tests in Amari's Case

A patient named Amari was brought to the emergency department with symptoms such as numbness, paralysis in her facial region and arm. Despite diagnostic results showing no intracranial changes (CT scan) and no damages in the nervous system (MRI scan), it is possible that she experienced a transient ischemic attack (TIA) due to high blood pressure. The symptoms are typically associated with TIA, which is more common among individuals above 55 years old. A thorough analysis of the available data revealed that Amari showed hypertension, high cholesterol, and smoking habits, all of which are risk factors for TIA.

Case study
1.0. Background
Clinical reasoning is defined as thinking through the various aspects of patient care to arrive
at a reasonable decision regarding the prevention, diagnosis, or treatment of a clinical
problem in a specific patient (Masic et al., 2008). The present paper describes about Mrs
Amari, a 59 year old female patient. She had been brought to emergency department with
paralyzing symptoms and undergone for diagnosis. The clinical reasoning of the patient in
terms of situation of the patient and her status at the time of admission in to emergency
department has been discussed in the paper.
2.0. Situation of patient
The 59 year Amari was suffering from cardiovascular diseases. He was with past medical
history of hypertension and hypercholesterolemia. She had a habit of smoking for about 25
years however she quit about 10 years ago. Being a New Zealand born lady, married an
Australian man. She was not doing a regular physical exercise but involving in occasional
walk with friends. It appears the family is belonging to middle class socioeconomic state as
her father was used to work at a construction site. She is having two daughters and her
husband is not having any kind of health issues. She complains of ‘numbness’ towards right
side from face and right arm, diverting the right side of mouth and slight facial drop. The
problems are probably due to hypertension induced stroke (Iadecola & Davisson, 2008). The
transient ischemic attack (TIA) is a transient scene of neurologic brokenness brought on by
ischemia (loss of blood stream) at central nervous system and/or spinal cord leading to an
intense localized necrosis (Sorensen & Ay, 2011). TIA is characterized by weakness,
numbness/paralysis at facial region, arm or leg, typically on one side of body, slurred speech
or difficulty understanding others and blindness in one or both eyes or double vision. The
causes of TIA includes smoking, high blood pressure, high cholesterol, diabetes, and family
history. As Amari does suffer from hypertension and high cholesterol, she was attacked from
TIA. TIAs occur due to the disruption of oxygen delivery in the brain leading to temporary
loss of consciousness without influencing the pulse. In contrast, CVA occurs due to death of
brain tissues leading to the paralysis and death. In nutshell, TIA is not so harm to the health if
treatment is initiated early stages in comparison to CVA.
3.0. Collect cues and information
Upon admission in Emergency department, the vital parameters were recorded along with the
physical appearance. The data from preliminary investigations indicates that the blood
pressure is high (148/97 mm of Hg). The Glasgow Coma Scale values of 15 indicates that the
eye opening, verbal and motor responses are quite well therefore the response was 15 (Reith,
et al., 2016). Other vital parameters such as breathing rate, heart rate and pulse rate are in
normal range. The major obstacle for the disease is hypertension. The hypertension was due
to narrowing of blood vessels as a result of cholesterol and lipids in the lumen of blood
vessels. This makes vessels to narrow lumen and also the elastic properties of vessels is going
to be lost leading to increase of pressure within the vessel. This reduces the blood flow and
supply of blood to brain tissue leading to delivery of in sufficient amount of oxygen and
eventually to necrosis of tissue. Therefore the brain parts that supply to organs functions are
expected to collapse. Eventually it appears as the symptoms as numbness, alterations in
mouth direction and speech and paralysis of arm. However there are no prominent evidences
in the CT scan and MRI scans indicating that there are no intracranial changes (CT scan) and
no damages in nervous system (MRI scan). As she was brought to the emergency department
at beginning stage, she was probably not shown any evidence of damage to brain tissue.
1

Despite of diagnostic results, from the symptoms it can be understood that Amari was
associated with TIA due to high blood pressure. However she was not shown any evidence of
damages in central and peripheral nervous system regions. The evidences of symptoms
support the probability of TIA. The symptoms include numbness, paralysis at facial region
and arm are typically associated with TIA.
4.0. Analysis of the evidences
The available data has been analyzed in order to interpret the factors contributing for TIA.
The factors or causes responsible for TIA includes, high blood pressure, high cholesterol,
cardiovascular disease, carotid artery disease, peripheral artery disease, diabetes, high levels
of homocysteine, habit of smoking and excess weight (Martín-Timon et al., 2014). Among
the factors, it was evidenced that Amari showed hypertension, high cholesterol and smoking
and GCS of 11. She felt a perception of numbness towards right side with unclear speech, no
dysfunction of pupils, however the right arm is relatively weaker than her left arm. She do not
possess the evidence of headache, nausea, vomiting chest pain etc. The risk of occurrence is
related to the age i.e., patient with above 55 years in general are prone to attack TIA. The
cues related to past medical history and family history can be collated in order to elucidate
the probable causes of TIA. The cues collected from the patient support the clinical team in
identifying the symptoms of the disease (Benner et al., 2008). The patient has to be subjected
for diagnosis utilizing CT and MRI scans. Another symptom, carotid bruit was observed i.e.,
a typical sound hear over and near to the carotid artery area during auscultation (Paraskevas
et al., 2008). The neurological status of the patient in terms of speech for lack of adequate
articulation, numbness due to disruption of nerve cells.
5.0. Conclusions
The finding for the consequences of symptoms over-dependence is required. The outcome
from numerous causes and are connected with both explanatory and non-investigative
thinking. The learnings provides a sheltered and quality medicinal services requires
specialized mastery, the capacity to think basically, encounter, and clinical judgment. The
elite desire of attendants is needy upon the medical caretakers' constant learning, proficient
responsibility, free and associated basic leadership, and imaginative critical thinking
capacities.
2

References
Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decisionmaking, and Action:
Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality:
An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare
Research and Quality (US); 2008 Apr. Chapter 6. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK2643/
Iadecola, C., & Davisson, R. L. (2008). Hypertension and Cerebrovascular Dysfunction. Cell
Metabolism, 7(6), 476–484. http://doi.org/10.1016/j.cmet.2008.03.010
Martín-Timón, I., Sevillano-Collantes, C., Segura-Galindo, A., & del Cañizo-Gómez, F. J.
(2014). Type 2 diabetes and cardiovascular disease: Have all risk factors the same
strength? World Journal of Diabetes, 5(4), 444–470.
http://doi.org/10.4239/wjd.v5.i4.444
Masic, I., Miokovic, M., & Muhamedagic, B. (2008). Evidence Based Medicine – New
Approaches and Challenges. Acta Informatica Medica, 16(4), 219–225.
http://doi.org/10.5455/aim.2008.16.219-225
Paraskevas, K.I., Hamilton, G & Mikhailidis, D.P (2008) Clinical significance of carotid
bruits: an innocent finding or a useful warning sign? Neurol Res. 30(5):523-30.
Reith, F.C., Van den Brande, R., Synnot, A & Maas, A.I (2016). The reliability of the
Glasgow Coma Scale: a systematic review. Intensive Care Med. 42(1), 3-15. doi:
10.1007/s00134-015-4124-3. Epub 2015 Nov 12.
Sorensen, A. G., & Ay, H. (2011). Transient Ischemic Attack Definition, Diagnosis, and Risk
Stratification. Neuroimaging Clinics of North America,21(2), 303–313.
http://doi.org/10.1016/j.nic.2011.01.013
3