What diagnostic studies need your immediate attention? What is the patient's short-term stroke risk? These experts outline a rational approach to this often underestimated emergency.

AJN, American Journal of Nursing, November 2006, Volume 106 Number 11, Pages 40 - 49.

A TIA is a small stroke or local bad circulation in the brain that lasts a short time without cerebral infarction, or a small brain infarction with rapid clinical recovery. TIA's are reversible focal neurological deficits persisting for less than 24 hours but usually the duration is a matter of minutes rather than hours. In a cooperative study, the median duration of carotid TIA's was found to be fourteen minutes and of vertebrobasilar events eight minutes. Ninety per cent of carotid TIA's lasted less than six hours, and ninety per cent of vertebrobasilar TIA's lasted less than two hours.

Published: Sunday, Feb. 5, 2006. Registration is required to view this article.

Scientists hope a new drug could cut the risk of serious disability following a stroke. Last Updated: Thursday, 9 February 2006, 11:35 GMT

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Despite Treatment, Brain Artery Narrowing Still Deadly

Last updated August 29, 2004

A cerebrovascular event traditionally has been used to describe the pathophysiologic entities of reversible ischaemia, infarction or haemorrhage of the central nervous system. Mechanisms of cerebral ischaemia include arterial embolism, thrombosis, thromboembolism, small vessel disease and haemodynamic disturbances that may involve a myriad of different blood vessels of different sizes. These processes may be a consequence of hypertension, diabetes, atherosclerosis, valvular heart disease, cardiac dysrhythmias or cardiac wall motion dysfunction. Uncommon causes include vasculitides, coagulation disorders, atrial myxoma and paradoxical embolism. Rarely venous infarction of the brain may occur as a consequence of venous or sinus thrombosis. Haemorrhage may occur into the subarachnoid or subdural space or within the brain parenchyma and may be due to hypertension, aneurysms, vascular malformations, trauma, coagulopathies or occur without clear cause.

June 2005 Ischemic stroke is the most common type of stroke accounting for about 40,000 cases annually in Canada. In the great majority of cases, the cause is an acute occlusion of intracerebral arteries caused by thrombus originating either from proximal arterial atherothrombotic lesions or from an intracardiac source. Because thrombolytic therapy has been shown to restore vessel patency rapidly in different vascular beds, its use in acute cerebral ischemia appears reasonable as the brain is particularly sensitive to ischemia. Although several drugs (tissue plasminogen activator, urokinase, pro-urokinase, streptokinase) have been tested in this clinical context, only tissue plasminogen activator (t-PA) has been approved for treatment of acute ischemic stroke in Canada.

Signs, Symptoms, and Risk Factors in Ischemic Stroke. US Pharmacist Vol. No: 28:10 Posted: 10/15/03

June 2004

A Division of the American Heart Association. They have a good Stroke Connection Magazine.

Internet Handbook of Neurology

Stroke. 2007;38:1655. © 2007 American Heart Association, Inc. Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.

The nation's leading supporter of biomedical research on disorders of the brain and nervous system

Both TIA and stroke are markers of impending disability TIAs ARE NOT BENIGN DERK W. KRIEGER, MD Section of Stroke and Neurological Intensive Care, The Cleveland Clinic Foundation

A transient ischemic attack is a "mini-stroke" caused by temporary disturbance of blood supply to an area of the brain, resulting in a sudden, brief decrease in brain function. (It lasts less than 24 hours, usually less than one hour).

Men in Nursing, October 2006, Volume 1 Number 5, Pages 18 - 27

Strokes are usually associated with the very old, not the very young. However, strokes occur in children more frequently than brain tumours, at a rate of three per 100,000 children in Canada annually.

Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked as a result of being stretched. The injury often results from extreme rotation in which the practitioner's hands are placed on the patient's head in order to rotate the cervical spine by rotating the head. The vertebral artery, whch is shown in the picture to the right, is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection. This article was revised on July 2, 2006.