Transient Ischemic Attack

The transient ischemic attack is a neurological emergency which is a clinical view of focal cerebral, retinal, or spinal dysfunction that lasts less than an hour, without any detectable acute infarction in neurological imaging methods. TIA is a serious warning for ischemic stroke, and this risk is particularly high in the first 48 hours. Following TIAs, approximately 10-15% of patients undergo stroke in 90 days and about half of these patients suffer a stroke in the first two days. Neuroimaging and laboratory studies should be performed quickly to reveal the etiology and to reduce the risk of stroke that may develop in patients present with TIA. Therapeutic and preventive interventions should be started as soon as possible. With early diagnosis and treatment, the risk of a 90-day stroke in these patients can be reduced by 80%. In addition to antiplatelet and anticoagulant treatments, aggressive control of blood pressure, regulation of blood sugar, statin, dietary recommendations, exercise, and managing the other underlying specific conditions should be started quickly.

Study of clinical profile and outcome of patients with acute non-traumatic paraparesis

Background: The following study is about the clinical profile and outcome of patients with acute non traumatic paraparesis. It includes the aetiology, clinical presentation and the outcome of various cases of acute non traumatic paraparesis. Paraplegia or paraparesis could be defined as loss of function of both legs as a result of disease or injury of the spinal cord, spinal roots, peripheral nerves or myopathies. Acute non-traumatic paraparesis is a neurological emergency. Reversible causes of acute paraplegia can be treated successfully if diagnosed early.Methods: The observational study was done in the department of general medicine at D. Y. Patil Hospital, Navi Mumbai with sample size of 75 patients over 1 year.Results: With early diagnosis prognosis of acute non traumatic paraparesis can be improved which was evaluated over period of 3 months.Conclusions: Acute non-traumatic paraparesis is a neurological emergency. Reversible causes of acute paraplegia can be treated successfully if diagnosed early. It is important to diagnose and classify all cases into compressive and non-compressive lesions based on presenting symptoms because the management of the two differs.

Age-Dependent Differences in the Rate and Symptoms of TIA Mimics in Patients Presenting With a Suspected TIA to a Neurological Emergency Room

Background: Transient ischemic attack (TIA) needs further diagnostic evaluation to prevent future ischemic stroke. However, prophylaxis can be harmful in elderly if the diagnosis is wrong. We aimed at characterizing differences in TIA mimics in younger and older patients to enhance diagnostic accuracy in elderly patients.Methods: In a dedicated neurological emergency room (nER) of a tertiary care University hospital, patients with transient neurological symptoms suspicious of TIA (<24 h) were retrospectively analyzed regarding their final diagnoses and their symptoms. These parameters were compared between patients aged 18–70 and >70 years using descriptive, univariable, and multivariable statistics.Results: From November 2018 until August 2019, 386 consecutive patients were included. 271 (70%) had cardiovascular risk factors and all patients received cerebral imaging, mostly CT [376 (97%)]. There was no difference in the rate of diagnosed TIA between the age groups [85 (46%) vs. 58 (39%); p = 0.213].TIA mimics in the elderly were more often internal medicine diseases [35 (19%) vs. 7 (5%); p < 0.001] and epileptic seizures [48 (26%) vs. 24 (16%); p = 0.032] but less often migraine [2 (1%) vs. 20 (13%); p < 0.001]. The most frequent symptoms in all patients were aphasia and dysarthria [107 (28%) and 92 (24%)]. Sensory impairments were less frequent in elderly patients [23 (11%) vs. 54 (30%); p < 0.001]. Impaired consciousness and orientation were independent predictors for TIA mimics (p < 0.001) whereas facial palsy (p < 0.001) motor weakness (p < 0.001), dysarthria (p = 0.022) and sensory impairment (p < 0.001) were independent predictors of TIA.Conclusion: TIA mimics in elderly patients are more likely to be internal medicine diseases and epilepsy compared to younger patients. Excluding internal medicine diseases seems to be important in elderly patients. Facial palsy, motor weakness, dysarthria and sensory impairment are associated with TIA.

Efficacy of Intravenous Hydrocortisone Treatment in Refractory Neonatal Seizures: A Report on Three Cases

Neonatal seizures are the most common neurological emergency, and neonatal status epilepticus (NSE) remains a controversial entity, with no general consensus about its definition and treatment. Here, we report on three newborns with NSE refractory to first- and second-line antiepileptic drugs successfully treated with intravenous (IV) hydrocortisone. The patients had previously failed therapy with levetiracetam, phenobarbital and midazolam, showing persistent clinical and electrical seizures. Modulation of brain inflammation triggered during prolonged epileptic activity has been thought to potentially explain the beneficial effects of anti-inflammatory treatment.