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Emergency phys

Mr. C, the episode when you couldn't talk right was the result of decreased blood flow to your brain. This was temporary, but it was a warning that a more serious event may occur in the future. We use the phrase Transient Ischemic Attack or TIA to describe this--it just means that there was a brief interruption of blood flow. We'll need to do a more complete physical exam as well as some further testing to help us figure out just what caused this to happen.

At this point I would probably ask Mr. C if he knows what a stroke is. (Some people confuse stroke with myocardial infarction). In the most common kind of stroke, blood flow to part of the brain has been permanently blocked. This can cause problems like inability to speak, paralysis, coma or even death. You're fortunate in that you've been given a warning that you may have disease in the blood vessels of your brain. Your age, gender, race, and history of hypertension all increase the chances of your having this problem. However, we have new medications, and can also help you make other changes in your life that will reduce the risk of your having a stroke.

We have started you on aspirin. This is an amazing drug that decreases pain and also thins the blood, making it less likely that you'll have a clot in your brain. Aspirin may prevent or at least decrease the chances that you will have another episode like the one you just had. A daily aspirin has also been shown to be protective against cardiac disease, which you may also have. This is why we advise most men over the age of 40-45 to take a daily aspirin.

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Emergency Room Physician Notes

Physicians in the Emergency Department were the first to see Mr. C. Our job was to figure out why he could not talk clearly at breakfast. Before making a tentative diagnosis of TIA, we would consider a differential of other conditions that could present in this fashion. A detailed history from the patient and his wife would rule out a more chronic mental status change, head trauma, or side effects of medications. Bedside evaluation would determine blood sugar levels, and pulse oximetry detect any hypoxia. We would also look for some indication of generalized hypotension or cardiac arrhythmia, which might have reduced overall systemic blood flow and contributed to his symptoms. If our initial work-up suggested the diagnosis of a TIA, we would request a consult with a neurologist to help guide Mr. C's further evaluation.