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DIFFERENTIAL DIAGNOSIS CEREBRAL THROMBOSIS AND TIA
Differential Diagnosis
Vascular disorders are mistaken for ischaemic stroke include intracerebral hemorrhage, subdural or epidural hematoma , and subarachnoid hemorrhage from rupture of an aneurysm or vascular malformation. These condition can often be distinguished by a history of trauma or of excruciating headache at onset, a more marked depression of consciousness, or by the presence of neck stiffness on examination. They can be excluded by CT scan or MRI.
Differential Diagnosis: Other structural brain lesion such as tumor or abscess can also produce focal cerebral symptoms of acute onset. Brain abscess is suggested by concurrent fever, and both abscess and tumor can usually be diagnosed by CT scan or MRI. Metabolic disturbances, particularly hypoglycemia and hyperosmolar nonketotic hyperglycemia, may present in stroke like fashion. The serum glucose level should therefore be determined in all patients with apparent stroke.
DIFFERENTIAL DIAGNOSIS CEREBRAL THROMBOSIS AND TIA
Differential Diagnosis
Vascular disorders are mistaken for ischaemic stroke include intracerebral hemorrhage, subdural or epidural hematoma , and subarachnoid hemorrhage from rupture of an aneurysm or vascular malformation. These condition can often be distinguished by a history of trauma or of excruciating headache at onset, a more marked depression of consciousness, or by the presence of neck stiffness on examination. They can be excluded by CT scan or MRI.
Differential Diagnosis: Other structural brain lesion such as tumor or abscess can also produce focal cerebral symptoms of acute onset. Brain abscess is suggested by concurrent fever, and both abscess and tumor can usually be diagnosed by CT scan or MRI. Metabolic disturbances, particularly hypoglycemia and hyperosmolar nonketotic hyperglycemia, may present in stroke like fashion. The serum glucose level should therefore be determined in all patients with apparent stroke.
Treatment of Cerebral Thrombosis and Transient Ischemic Attacks
The current treatment of it may be divided into four parts:
Management in the acute phase
Measures to restore the circulation and arrest the pathologic process
1. Thrombolytic agents ( t-PA only for completed stroke,w/in 3~6hrs ) 2.Anticoagulant drugs ( Heparin, LMWH & warfarin)
3. Antiplatelet drugs ( Aspirin or Clopidogrel, Dipyridamole or Ticlopidine )
4.Difibrase
5. Neuroprotective agents: barbiturates, opioid antagonist naloxone,Manitol
Treatment
Treatment of cerebral edema and raised intracranial pressure
Acute surgical revascularization
Surgery for symptomatic carotid stenosis, Carotid endarterectomy, intralumenal stents, extracranial-intracranial bypass
Physical therapy and rehabilitation.
Measures to prevent further strokes and progression of vascular disease.
- Since the primary objective in the treatment of atherothrombotic disease is prevention , efforts to control the risk factors must continue.
- Aspirin
- Hypotensive agents
- Oversedation should be avoided
- Systemic hypotension, severe anemia should be treated promptly
- Particular care should be taken to maintain the systemic blood pressure, oxygenation and intracranial blood flow during surgical procedures, especially in elderly patient.
Course and Prognosis
When the patient is seen early in the cerebral thrombosis, it is difficult to give an accurate prognosis.
As for the eventual or long-term prognosis of the neurologic deficit , there are many possibilities.
It must be mentioned that having had one thrombotic stroke, the patient is at risk in the ensuing months and years of having a stroke at the same or another site, especially if there is hypertension or diabetes mellitus.
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