Paul has been feeling very tired and has been having sudden weakness and numbness on one side of his body. He calls the hospital asking if this is anything to be concerned about. How do you respond?
1. What is the neurological problem Paul is most likely encountering?
There are two common neurological problems that are usually associated with the symptoms of sudden weakness and numbness on one side of the body. These two conditions are somewhat related in terms of the mechanism. Stroke is a form of medical emergency simply because it is usually caused by problems affecting the flow of blood to the patient's brain while the transient ischemic attack is also similar in the cause but it is not due to blockage but due to breakage in the blood vessels supplying the brain. A look at the symptoms of Paul shows that the brain is being affected by the blood flow which simply means that nutrient and oxygen would be deprived off from the brain affecting the functional capability of the brain sending the necessary information out or receiving the needed ones.
This will affect the response of the brain. Another major problem this will cause is the death of the brain tissue. My understanding of this condition will aid my response. I will advise Paul to seek an emergency medical management to prevent the death of the brain tissues which are usually very fast once there are no blood supplies. There are several treatment protocols in emergency units of hospitals that can help respond to the Paul symptoms on time to prevent the complications of these conditions. Afterwards the etiology can then be unraveled. In the Paul’s case now considering the fact that the symptoms have not yet been experienced for more than 24 hours, his neurological problem is then considered to be transient ischemic attack (TIA).
2. What part of the nervous system is effected?
3. There are several other signs and symptoms associated with TIA. These include;
- Sudden abnormal feeling of movement (vertigo) or dizziness
- Change in alertness which it will be seen to affect the sleep, patient become less responsive and unconscious.
- There are situations where patient start feeling somehow in terms of the touch, pain, temperature, pressure, hearing, and taste.
- There is also some level of confusion or memory loss.
- Problems with swallowing.
- Writing and reading becomes an issue in some people.
- Drooping of the face especially on the affected side.
- Affected individual finds it difficult to recognize other people and friends.
- Incontinence might result as a result of lack of control over the bladder or bowels.
- Vision is affected in one or both eyes in some cases.
- One of the major symptoms which is numbness and tingling sensation of a side of the body.
- Affectation of the patients’ personality, the mood, or emotion.
- Words or communication difficulties.
- Weakness on one side of the body
In terms of the signs of TIA, most times before the patient get to the hospital, the symptoms might have disappeared. However, there are investigations or physical examination that could be conducted by the physician to detect the problems. There might be bruits sign heard when the physician used stethoscope to listen to the blood flow of the carotid artery. Others are related to signs from investigations such as the use of head CT scan or brain MRI to know the blocked vessels, carotid duplex to know if carotid arteries are narrowed.
4. Name the three vascular disorders that cause this type of problem.
The major vascular disorders that are usually noted as a risk factors or causes transient ischemic attack are the; Atherosclerosis, Atrial Fibrillation and Carotid artery disease.
5. Name the goals of treatment for this patient.
There are different treatment goals for the management of transient ischemic attack. Those goals will be listed below.
1. Prevention of occurrence of stroke
2. Reduction of blood pressure
3. Prevention of arterial stenosis
4. Specialist assessment
6. Discuss the intervention and/or assessment for this patient please generalize the intervention/treatment for this patient overall
There is several treatment protocols that are being prepared for the management of patients with TIA. The most important of all is an urgent transfer to the emergency unit of hospital for evaluation/assessment and intervention. In most cases, symptoms are usually reduced or disappear before the patients get admitted in the hospital however, that does not give an indication that there is no risk for recurrence or development of stroke very soon. It is important for the managing physician to evaluate the risk and initiate the stroke prevention therapy which is an important tool to help the patient.
Rapid evaluation unit or observation unit is present in some environment (Nanda). In these type of community, evidence based studies have proved the approach to be beneficial by showing a reduction in stroke risk from 10 percent to 2 percent within 90 days stroke risks (Nanda).
Managing of blood pressure
Medical history presented in respect of Paul's condition, there is no information to show the other signs and symptoms Paul might be associated with. In this situation, Paul will be managed with the management protocol used for patient with TIA. In such situation, hypertension will be managed unless there is no history of hypertension. This would have been evaluated with the assessment or evaluation protocol.
The blood pressure will be managed conservatively and ensured it falls towards the normal blood pressure of 130/90mmHg.
Pharmacologic management
Apart from this approach, pharmacologic therapy will also be instituted. This will focus on implementing antithrombotic therapy which will help reduce the short-term risk of stroke but the intracranial hemorrhage must have been ruled out before this therapy is initiated. If Paul's evaluation shows a case of noncardioembolic transient ischemic attack, then the therapy that would be used will be antiplatelet agents. This will be in form of Aspirin 50-325 mg/day. For first line option, a combination of aspirin with extended release dipyridamole and clopidogrel can be given.
If evaluation of Paul shows a case of Cardioembolic transient ischemic attack, the treatment will be based on long-term anticoagulation using warfarin. Aspirin 325mg/day is also given in case Paul is unable to take oral anticoagulants. Other pharmacotherapy management protocols are; oral anticoagulation with warfarin in case of acute myocardial infarction or dilated cardiomyopathy.
If the cause is linked with intracranial atherosclerosis, the management protocol using medication will be based on the use of Aspirin 50-325mg/day, maintenance of blood pressure below 140/90, cholesterol reduction below 200mg/dl, extracranial or intracranial bypass surgery and angioplasty. In case the etiology is linked to the ipsilateral carotid artery stenosis, the right response will be to perform the carotid endarterectomy within 2 weeks. In some patients, carotid artery angioplasty and stenting can be an alternative treatment protocol.
Consultation
Apart from the listed treatment protocols, it will be necessary for specialists (consultant neurosurgeon, vascular surgeon and cardiologist) to evaluate Paul. The cardiologist will help clear any cardiac related findings that could influence stroke risk. The consultant vascular surgeon will help manage cases that could be related to vessel stenosis or occlusion while the neurosurgeon will take charge of all other neural aspect.
Long term monitoring
Long term monitoring will also be essential to help manage Paul effectively so as to monitor the responses to medication, risk factors and any modification that could be a risk. In the long term monitoring evaluation, blood pressure will be monitored, lipid control achieved, blood glucose monitored, prevention of any form of smoking, reduction in weight, alcohol reduction and exercise.
Work Cited
Karen et al. Patient information: Transient ischemic attack (Beyond the Basics). UptoDate. 21. Web. 17 November, 2013.
MayoClinic. Transient Ischemic attack (TIA). Diseases and conditions. Health information. 3 March, 2011. Web. 17 November, 2013.
Nanda, Ashish. Transient Ischemic Attack Treatment & Management. Reference. Medscape. 20 July, 2013. Web. 16 November, 2013.
PubMed Health. Transient ischemic attack. 21 May, 2012. Web. 17 November, 2013.
Solenski, Nina. Transient Ischemic Attacks: Part II Treatment. 1 April, 2004. Web. 17 November, 2013.
