Transient Ischemic Attack (TIA) Case Study

This assignment presents a case study of Mrs. Amari, a patient experiencing a Transient Ischemic Attack (TIA). The analysis delves into the potential causes of TIA, including large artery atherosclerosis and lifestyle factors like diet. It explores the neurological examination process used to assess Mrs. Amari's condition and highlights the importance of lifestyle changes, medication, and ongoing monitoring to prevent future strokes.

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Name
University

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Transient Ischemic Attack is caused due to interruption in the supply of oxygen to the
brain. There are several symptoms that differentiate it from an ischemic stroke. The chances
of suffering from TIA increase with age, being a woman, having conditions like, diabetes,
hypertension and dyslipidemia. Treatment can include medication for prevention of clot
formation or even surgery. Life style modifications are important in preventing a recurrence
or a stroke. Angioplasty or stenting may be necessary in some patients. A neurological exam
helps to assess the extent of damage that a TIA has caused in a patient.
A Transient Ischemic Attack is caused due to a temporary interruption of blood flow
to a part of the brain due to the presence of a clot. This disrupted blood flow causes lack of
oxygen in the brain which lead to stroke like symptoms, this is why an ischemic attack is
referred to as a mini stroke. Since it is a brief and reversible neurological deficit, it does not
cause permanent damage to the brain. Whereas, a stroke causes permanent damage in the
brain. But several symptoms of a Transient Ischemic Attack are similar to those of a stroke.
Disturbances in speech and vision of one or both eyes, feeling numb in the arms, legs and
face occur in Transient Ischemic Attack and stroke. But these last for upto a few minutes to
24 hours in case of a Transient Ischemic Attack (Khare, 2016)
Incidence of TIA is more common in women. In a survey conducted on 46971
patients with TIA, the mean age at the time of occurrence was 71 years. Among men and
women aged 65 years or more the annual rates of TIA declined from 5.8/1000 to 4.8/1000
among men and from 5.3/1000 to 4.2/1000 among women. The decrease was associated with
better care received at public health hospitals, stroke unit care and reduction of vascular risk
due to medication and primary and secondary measure employed for prevention
(Sundararajan, et al., 2014). In the US 200,000 to 500,000 persons are diagnosed by doctors
to have suffered from a TIA every year. But an additional 300,000 to 700,000 patients do not
seek treatment and the incidence of TIA among them is not on records. The risk of suffering

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from the debilitating effects of an ischemic stroke is higher in people who do not seek
treatment after an episode of TIA. The risk is particularly highest in the first 24 hours, the
first week and lessens after a few weeks. So, TIA should be treated as an emergency so that,
further complications can be prevented (Sorensen & Ay, 2011). In many cases a TIA occurs
due to either asymptomatic or symptomatic carotid stenosis, extracranial vertebral artery
atherosclerosis or intracranial atherosclerosis (Cole, 2017). Imaging studies help in the
diagnosis of this set of diseases (Uehara, et al., 2015 ). Carotid re-vascularilization is often
recommended or patients with severe stenosis (Cole, 2017). Other therapy may involve an
anti-platelet therapy, blood pressure control, reduction of low density lipoprotein, and
extensive lifestyle modification that includes controlling blood glucose levels within the
normal range.
Symptoms experienced by TIA patients are often similar to the those experienced by
patients of ischemic stroke. But as the name suggests, these symptoms are of transient
nature. Weakness in limb is usually unilateral, slurred speech, monocular blindness or even
binocular blindness or blurred vision is experienced by some patients. Limb shaking occurs in
TIA patients but does not occur in patients due to ischemic stroke. At times, patients may
report hemivisual field vision defects or ataxia of the limbs, but these symptoms may be due
to some other underlying cause and are not caused due to Transient Ischemic Attack. Imaging
techniques may help understand the cause of such associated symptoms. How symptoms re
perceived by patients and their physicians depends on their gender, education and race (Kim,
2014).
The propensity to suffer from TIA is greater in patients with hypertension, diabetes,
dyslipidemias patients who have had a TIA before are advised to follow a prescribed diet,
exercise regularly, limit intake of alcohol and cessation of tobacco use. Surgical procedures
may have to be done on some patients for revascularisation of the carotid artery. At times

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stenting or angioplasty may also be required if the stenosis in the carotid artery exceeds 70%
(Barrett & Brott, 2017 ).
The definition of how TIA is diagnosed is undergoing a change. Rather than the time
of less than 24 hours, it is now based on the tissue, that is, it should be without tissue
infarction, as per this concept, it is termed acute cerebro-vascular syndrome (Sato &
Minematsu, 2013).
Mrs. Amari has hypertension and hypercholesterolemia. Both the conditions put her at
a high risk of Transient ischemic stroke. Both the conditions predispose a person to a TIA.
the formation of a blood clot occurs and it travels to the brain where it gets lodged in a
narrow artery, it is either quickly dislodged or other arteries begin supply of oxygen to the
brain tissue that was without oxygen for a small time. The clot may originate at an atheroma
on an inner lining of an artery, carotid artery. Atheroma is formed due to the deposition of
fats and narrows the arteries. Patients with high cholesterol are at a higher risk. Atheroma is
also a site for the formation of clots. It is also called athersclerosis of the artery or plaque.
The carotid artery is the artery that carries blood from the heart to the brain.
Being a woman and aged increases the risk for Mrs. Amari even further. But she can
reduce risk only by controlling hypertension through proper medication, diet and some
physical exercise. Consumption of better fats and less fats in the diet along with medication
can reduce her blood cholesterol. She has to continue taking these precautions after
recovering from the TIA, because someone who has had a mini stroke is at a higher risk of
suffering from another TIA or an ischemic stroke.
Neurological assessments carried out on a patient with changed neurological status
include- assessment of the level of consciousness, pupillary reaction, checking vital signs,
evaluation of motor function and sensory and cranial function. It is assessed whether patient

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is fully conscious, is drowsy or unconscious to determine the level of consciousness.
Respiration, temperature, blood pressure and pulse are checked to assess the patient's vital
signs. Pupillary action is checked with the help of a bright, narrow beam of light from a torch,
when it is shone into the eyes, a rapid constriction means that the mid-brain is intact. Slow
constriction points to some problem. Flexion and extension of the limbs is observed to study
the motor function (Mooney & Comerford, https://www.nursingtimes.net).
In conclusion, lifestyle changes can help prevent further strokes in patients diagnosed
with TIA. In Mrs Amari's case a neurological examination will help assess the what treatment
should be given to her to treat her and prevent further attacks or strokes.

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References
Barrett, K. & Brott, T., 2017 . Stroke Caused by Extracranial Disease.. Circulation Research,
120(3), pp. 496-501.
Cole, J., 2017. Large Artery Atherosclerotic Occlusive Disease.. Continuum (Minneap Minn).
, 23(1, Cerebrovascular disease), pp. 133-157.
Khare, S., 2016. Risk factors of transient ischemic attack: An overview. Journal of Mid-Life
Health, 7(1), pp. 2-7.
Kim, J., 2014. Symptoms of transient ischemic attack.. Frontiers of Neurology and
Neuroscience, Volume 33, pp. 82-102.
Mooney, G. & Comerford, D., https://www.nursingtimes.net.
neurological-observations/205473.article. [Online]
Available at: https://www.nursingtimes.net/clinical-archive/neurology/neurological-
observations/205473.article
[Accessed 20 August 2017].
Sato, S. & Minematsu, K., 2013. Transient ischemic attack: past, present and future. Brain
and nerve, 65(7), pp. 729-38.
Sorensen, A. G. & Ay, H., 2011. Transient Ischemic Attack Definition, Diagnosis, and Risk
Stratification.. Neuroimaging Clinics of North America, 21(2), pp. 303-313.
Sundararajan, V. et al., 2014. Trends over time in the risk of stroke after an incident transient
ischemic attack.. Stroke, 45(11), pp. 3214-8.
Uehara, T. et al., 2015 . Clinical, Laboratory, and Imaging Characteristics of Transient
Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and
Intracranial Arteries.. Cerebrovascular diseases extra, 5(3), pp. 115-123.