Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1444 Transient Ischemic Attacks Trichinosis

hematologic causes of TIAs (polycythemia, sickle cell disease, hyper-

viscosity syndromes)

management

■Aspirin (optimal dose not established)

■Ticlopidine

■Initiate anticoagulant treatment w/ heparin & introduce warfarin (to

INR 2–3) for cardiogenic embolism

specific therapy

Carotid endarterectomy for ipsilateral localized stenotic lesion (70% or

more)

Treat or control cardiac arrhythmia or continue warfarin

General measures: stop cigarette smoking, treat underlying medical

disorders (polycythemia, hypertension, diabetes, hyperlipidemia)

follow-up

■As necessary to control anticoagulants for disturbance of cardiac

rhythm

■Every 3 months to ensure no further TIAs or episodes of amaurosis

fugax

complications and prognosis

■30% of pts w/ stroke have history of previous TIAs

■Pts w/ TIA overall have an average 4% per year risk of stroke

■Symptomatic carotid stenosis >70% has a 13% risk over 2 years of

major or fatal stroke

TRICHINOSIS

J. GORDON FRIERSON, MD

history & physical

History

■Exposure: Eating undercooked pork, bear, wild boar, walrus, meat

of other carnivores, occasionally horsemeat. Larvae digested out of

muscle, penetrate small intestine, go to skeletal and cardiac muscle

via the circulation, encyst there.

Signs & Symptoms

■Intestinal phase: no symptoms, or mild diarrhea, bloating, abdomi-

nal pain 2–7 days after exposure.