Sunday, April 10, 2011

Dysphasia : TIA vs Complicated Migraine

Serene Branson while reporting live at the Grammy Awards suddenly began having difficulty speaking.She was hospitalized at UCLA Medical Center in LA and after a neurologic workup was diagnosed with migraine.She had no prior history of migraine and recovered completely.
Another TIA mimic may be related to seizures. For example, following a seizure , some patients may experience sided paralysis called Todd's paralysis which resolves without sequelae.
To aid the physician in diagnosis the ABCD2 algorithm score based on age, blood pressure, clinical features, a history of diabetes and TIA duration can predict stroke risk.
A prior history of unexplained transient neurologic attacks, the presence of non- specific symptoms, and gradual symptom onset can help differentiate between TIA and TIA mimics such as migraine.
With migraine, symptoms occur over minutes. In TIA's over seconds.
With TIA mimics, patients often report other non-focal symptoms such as lightheadedness, GI complaints and tightness of the chest.
In 2010, the American Stroke Association revised diagnostic criteria for TIA.
All of the aforementioned can assist the physician in making a correct diagnosis and most importantly identify those at risk for stroke.
AHA/ASA Guidelines for the prevention of stroke in patients with TIA's ( Stroke 2011; 42: 227-276)

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