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Stroke and Transient Ischemic Attack (TIA) contribute to the highest causes of both ischemic and non-ischemic neuronal damage. Therefore, it is critical to examine the physical and neurological signs of stroke and TIA patients (National Institute of Neurological Diseases and Stroke, 2019). The following neurological tests were done on the patients: facial and limb strength, cognitive and language examination, sensory function, deep tendon, and muscle coordination tests. Vital signs, including the blood pressure temperature for both patients, were physically examined. In my clinical assessment of the patient, I ensured that the documentation of the patient’s information was in line with the HIPPA guidelines (Moore & Frye, 2019). The health records, laboratory results, demographic and personal information, health histories, and medical bills were all handled cautiously to protect the safety of this data.
Patient 1 was previously admitted to the hospital on 5th February 2020 because of a fall. He was readmitted on 9th February 2020 because of cerebral ischemia caused by cerebral atherosclerosis. The patient was on an antihypertensive treatment using acebutolol and statin therapy to control cerebral atherosclerosis. Brain imaging in stroke and TIA patients plays a significant role in the diagnosis (Amarenco et al., 2018). The CT scan also established the cerebral arteries of both patients had massive old thrombi and laboratory examinations suggested that the patient was having a TIA as brain imaging showed a thrombus in the middle cerebral artery.
Physical examination proved that patient two has a severe form of neurologic disease. The contracted right side of the patient revealed that he had a stroke. The patient was on statin medication, benzodiazepines, and antihypertensive drugs. The individual was previously under tissue plasminogen activator (tPA) and aspirin, as he had previously experienced TIA incidences before the stroke. Brain imaging of the victim’s brain’s left hemisphere was atrophied and infarcted. Victims one and two both had reduced muscle strength, but this indicator was worse for the first patient than for the second one.
Electrophysiologic examination of both cases revealed ventricular hypertrophy, especially in the left ventricle. Hematological laboratory tests in both of them showed elevated platelet counts. MRI investigation showed edema in the hand and feet of the second patient. NIH stroke scale serves a significant function in TIA and stroke diagnosis (Majidi et al., 2017). The thrombus in the cerebral artery of the victim was the underlying cause of the TIA, while the hemispherical brain infarction and atrophy of the second patient caused the stroke. Both patients had a hypercoagulable state and thus increased the risk of suffering more complications.
Proper management of stroke and TIA helps reduce the disease severity and complications. According to the American College of Cardiology (2018), the administration of tissue plasminogen activator (tPA) is vital after admission of a subject suspected of TIA. The first patient was put under immediate tPA therapy to control his condition. It was given within the first three hours after the patient had been admitted to the hospital. Practitioners also educated him about the need to change his lifestyle practices, such as smoking cessation. Doctors also subjected the second patient to tPA therapy to prevent cases of coagulation on the contralateral side. Thrombotic treatment is essential for stroke victims to reduce the chance of blood thrombosis. Practitioners can achieve acute ischemic stroke treatment through lifestyle changes, medications such as aspirin and other anti-platelets, anticoagulants, antihypertensive drug therapy, and surgical intervention (Qiu & Xu, 2020). Treatment of the hypertensive patients’ underlying conditions was parallel to the stroke and TIA treatment of the patients. The second patient’s condition continued worsening, and I referred the patient to the Texas Neurological Center to continue his stroke management.
References
American College of Cardiology. (2018). 2018 AHA/ASA Stroke early management guidelines – American College of Cardiology.
Amarenco, P., Lavallée, P. C., Monteiro Tavares, L., Labreuche, J., Albers, G. W., Abboud, H., Anticoli, S., Audebert, H., Bornstein, N. M., Caplan, L. R., Correia, M., Donnan, G. A., Ferro, J. M., Gongora-Rivera, F., Heide, W., Hennerici, M. G., Kelly, P. J., Král, M., Lin, H.-F., & Molina, C. (2018). Five-year risk of stroke after tia or minor ischemic stroke.New England Journal of Medicine, 378(23), 2182–2190.
Majidi, S., Leon Guerrero, C. R., Burger, K. M., & Rothrock, J. F. (2017). Inpatient versus outpatient management of tia or minor stroke: Clinical outcome.Journal of Vascular and Interventional Neurology, 9(4), 49–53.
Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: History, protected health information, and privacy and security rules.Journal of Nuclear Medicine Technology, 47(4), 269–272.
Qiu, S., & Xu, Y. (2020). Guidelines for Acute Ischemic Stroke Treatment. Neuroscience Bulletin.
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