A 58-year-old man presents to the emergency department for evaluation following a 30-minute episode of left hand weakness. During the episode, the patient was unable to pick anything up with his left hand. He was able to lift his arm during the incident. He denies any difficulty with ambulation or speaking during the episode. The patient has a past medical history of uncontrolled hypertension and type 2 diabetes mellitus. He has a 20-pack-year history of smoking cigarettes. His temperature is 37°C (98.6°F), pulse is 101/min and irregularly irregular, and blood pressure is 196/98 mmHg. The patient’s pulse oximetry is 99% on room air. He is alert and oriented, with fluent, clear speech. Motor strength is normal in all extremities, and there are no focal deficits appreciated. Non-contrast CT-brain does not demonstrate an acute intracranial process. CT angiogram of the head and neck demonstrates diffuse calcific atherosclerosis. Without appropriate medical treatment, which of the following adverse events is this patient most likely to sustain?

A transient ischemic attack (TIA) is a transient episode of neurologic dysfunction caused by ischemia, without acute infarction. TIAs have the same underlying cause as strokes which is a disruption of cerebral blood flow. Symptoms usually last only a few minutes to an hour but may persist for up to 24 hours. TIAs cause the same symptoms associated with strokes, such as contralateral paralysis or sudden weakness or numbness.

A TIA may cause sudden dimming or loss of vision (amaurosis fugax), aphasia, dysarthria, and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or 24 hours. Having a TIA is a risk factor for eventually having a stroke or a silent stroke. Treatment may include blood thinners or antiplatelet medications to prevent blood clots, as well as lifestyle changes such as smoking cessation, exercise, and a healthy diet to lower the risk of further TIAs or stroke. In some cases, surgery may be necessary to remove a blockage in the blood vessels.

Transient ischemic attack

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