Internal Medicine

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

Transfusion Reactions Transient Ischemic Attacks 1443

■Delayed hemolytic transfusion reaction: 1/4,000 transfusions w/ lit-

tle impact on morbidity & mortality

■Transfusion-associated GVHD: very rare, w/ mortality approaching

100%

■PTP: very rare, w/ appreciable morbidity & mortality secondary to

prolonged thrombocytopenia

TRANSIENT ISCHEMIC ATTACKS

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Acute, focal ischemic neurologic deficit that clears completely within

24 hours, usually within a few minutes; nature & distribution of

symptoms depend on site of lesion; may consist of weakness, heavi-

ness, paresthesias, numbness, aphasia, amaurosis fugax, dysarthria,

diplopia or vertigo

■No abnormality except during attack, when may be pyramidal deficit,

sensory changes, speech disturbance, ataxia, reflex changes; may be

carotid bruit or cardiac arrhythmia

tests

■Basic: CBC, differential count, ESR, PT, PTT, FBS, lipid profile, RP,

electrolytes; consider also SPEP, fibrinogen, proteins C & S, ANA,

antiphospholipid antibody, antithrombin III, factor V Leiden

■Chest x-ray

■Cranial CT scan to show absence of hemorrhage; cranial & cervical

MRA – may show evidence of diffuse or localized vascular disease;

carotid duplex ultrasonography may reveal localized disease

■Cardiac studies: ECG, Echo

differential diagnosis

■Other causes of episodic neurologic deficit; focal seizures consist of

positive phenomena (clonic motor activity or paresthesias) rather

than negative phenomena (weakness, paralysis, numbness) & may

spread (“march”); pt’s age & family and past history may help to

distinguish migrainous phenomena

■Distinguish by above tests btwn intrinsic cerebrovascular dis-

ease, other vasculopathies (fibromuscular dysplasia, vasculitides,

meningovascular syphilis), cardiac causes of cerebral emboli,