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Transient Ischemic Attack

Transient Ischemic Attack

Transient Ischemic Attack or TIA can often come without a warning. This transcient stroke may last a few minutes. A transient ischemic attack is caused by a temporary clogging of the artery by a blood clot. This typically lasts less than five minutes. At the end of the TIA, there is no injury to the brain though there is temporary decrease in blood supply to the brain. Since TIAs are often a prelude to a more serious stroke, it is essential that factors such as high blood pressure, heart disease, diabetes and carotid artery disease must be carefully treated. Atherosclerosis is a major cause for cholesterol buildup in the arteries. A rare cause for transient ischemic attack is sudden and sharp drop in blood pressure resulting in reduced blood flow to the brain.

Typically a person suffering an Transient Ischemic Attack is likely to suddenly feel dizzy or have trouble seeing. There might be lack of coordination and balance. The person may experience numbness or weakness in the limbs, especially on one side of the body. Speech may become slurred and incoherent. It is essential that a person suffering TIA is seen immediately by medical personnel to determine appropriate treatment. The patient who has suffered TIA will be examined for heart murmurs or any narrowing of the carotid artery. The nervous system has to be evaluated for coordination and muscle strength. Diagsnotic tools such as ECG, brain scan and carotid Doppler are used to diagnose transient ischemic attack. MRI and arteriography helps in clearly viewing the arteries in the brain.

Most patients who have suffered TIA are prescribed aspirin. Those patients with a history of atrial fibrillation are put on anticoagulants such as heparin and warfarin. Anti-platelet drugs such as clopidogrel and dipyridamole aid in reduction of blood clotting. In cases of severely narrowed carotid artery, carotid angioplasty may be conducted to keep it open and prevent recurrence of stroke. A person who has suffered a TIA must maintain healthy body weight and follow regular exercise regimen.

Amaurosis

The term Amaurosis is taken from Greek meaning dark or obscure. It is loss of vision or weakness that occurs without any apparent lesion affecting the eye. Amaurosis is often a short lived episode of blindness in one eye and is referred to as 'fleeting blindness'. An episode of amaurosis if often frightening. Although the visual loss gradually resolves, it is advised to seek medical attention immediately as this may be one of the warning signs of a stroke. Amaurosis is caused due to blood clot or a small piece of cholesterol that breaks off from a large artery and travels upward to the brain or eye. This gets lodged in the main artery supplying blood to the eye. Amaurosis is also caused by blood clots from heart valves or the heart itself due to underlying heart disease.

There are various types of amaurosis. The Leber's congenital amaurosis is inherited. This results in optic atrophy and results in severe vision loss. Amaurosis fugax is a temporary loss of vision in one eye. This is caused by decreased blood flow to the retina. While the majority experiencing amaurosis have a complete symptom abeyance within a few minutes, there is a minority who experience a stroke or a vision loss as a result of amaurosis.

Diabetes, hypertension and smoking tend to aggravate this condition. Sometimes, surgical repair of the mitral valve may result in amaurosis. Deficiency of Vitamin B1 due to Thiamine related cerebrocortical necrosis can also result in amaurosis. Treatment of amaurosis depends mainly upon identifying the source of blood clots and cholesterol that have caused this block in the artery. An ultrasound of the carotid arteries of the neck, a study of the electrical system of the heart and a magnetic resonance angiography scan of the head and neck, an echocardiogram of the heart are often included to reveal the source of the problem and decide on the treatment options.

Hypertension

Hypertension or high blood pressure is a major problem afflicting one out of four adults in the United States alone. It is a precursor to other serious health complications - kidney disease, atherosclerosis, stroke and eye damage to name a few.

Normal Blood Pressure

For normal adults normal blood pressure is below 120/80 mmHg. In other words, the systolic pressure (when the heart pumps) should be below 120 and the diastolic pressure (when the heart relaxes) should be below 80. A reading between 120/80 and 140/90 might be seen as pre hypertension stage and in some cases may indicate the need for further investigation.

A reading above 140/90 indicates hypertension and requires a thorough investigation into the cause and treatment.

Cause of HyperTension

Many factors have been implicated in the development of hypertension - obesity, genetics, sodium sensitivity, glomerulonephritis and other kidney diseases, among other etiologies. Elevated levels of blood pressure can be also due to drug interactions. There are 2 kinds of hypertension - the primary hypertension where it occurs due to unknown etiology and the secondary hypertension which is the result of another underlying condition.

Diagnosis: Blood tests:

Renal Function - Creatinine
Electrolytes Level
Glucose - Glucose Tolerance Test
Cholesterol Level

In addition ECG may be ordered to check for left ventricular hypertrophy.

Treatment Options

Diuretics: bendroflumethiazide, chlortalidone, hydrochlorothiazide
Angiotensin Converting Enzyme (ACE) inhibitors: creatine captopril, enalapril, fosinopril, Monopril, lisinopril , quinapril, ramipril
Angiotensin II receptor antagonists: telmisartan, irbesartan, losartan, valsartan, candesartan
Alpha blockers: prazosin, terazosin.
Beta blockers: atenolol, labetalol, metoprolol, propranolol.
Calcium channel blockers: nifedipine, amlodipine, diltiazem, verapamil
Direct renin inhibitors: aliskiren