Transient ischemic attacks

Essentials of diagnosis
*focal neurologic deficit of acute onset
*clinical deficit resolves completely within 24 hours
*risk factors for vascular disease often present
If the ischemia is in the carotid territory,common symptoms are weakness and heaviness of the contralateral arm, leg, or face, singly or in any combination.
Numbness or paresthesias may also occur either as the sole manifestation of the attack or in combination with the motor deficit.
Vertebrobasilar ischemic attacks may be characterized by vertigo, ataxia, diplopia, dysarthria,dimness or blurring of vision, perioral numbess and paresthesias, and weakness or sensory complaints.
There may be slowness of movement, dysphasia, or monocular visual loss in the eye contralateral to affected limbs.
Treatment is initiated with iv heparin (in a loading dose of 5000-10000 units of standard-molecular weight heparin and maintenance infusion of 1000-2000 units per hour depending on the partial thromboplastin time), while warfarIn sodium is introduced in a daily dose of 5-15mg orally depending on inr. Warfarin is more effective than aspirin in reducing the incidence of cardioembolic. Aspirin 325mg daily may be used in patients with nonrheumatic atrial fibrillation. In patients intolerant of aspirin, clopidrogel 75mg can be used instead.