American Medical Association Family Medical Guide - American Medical Association [419]
Treatment
The treatment of a TIA focuses on preventing additional TIAs and a possible stroke. The preventive measures that a doctor may recommend depend on a person’s age and general health. You may be asked to take an aspirin once a day every day for the rest of your life. Aspirin helps prevent TIAs and stroke by reducing the risk of blood clots. Doctors sometimes prescribe other anticoagulant drugs instead of or in addition to aspirin. More powerful anticoagulants can help reduce the risk of stroke in people with abnormal heart rhythms. In some cases, a doctor may recommend a surgical procedure called carotid endarterectomy (see page 674) to remove the fatty deposits that have narrowed the arteries.
Transient ischemic attack
A transient ischemic attack is often caused by a clump of blood cells (a clot) flowing with the blood until it blocks a small artery in the brain. The effects of a transient ischemic attack are temporary; the clump quickly breaks up and is swept away in the bloodstream, restoring blood flow.
Subarachnoid Hemorrhage
The surface of the brain is covered by three membranes called meninges. The thick, outermost membrane, the dura mater, adheres to the skull, while the thin, innermost membrane, the pia mater, adheres to the brain. The middle membrane, the arachnoid, is closer to the dura mater than to the pia mater because the space between the arachnoid and the pia mater (called the subarachnoid space) is filled with cerebrospinal fluid. A subarachnoid hemorrhage occurs when blood leaks into the subarachnoid space, usually as the result of a ruptured aneurysm (see page 599). The blood may remain in the cerebrospinal fluid or it may burst through the pia mater into brain tissue when the aneurysm ruptures.
A major hemorrhage (one that causes loss of consciousness) can cause permanent brain damage or death. One third of people who survive a major hemorrhage have additional hemorrhages. The permanent damage that can result from a hemorrhage varies according to which areas of the brain are affected. A person can have partial paralysis, weakness, numbness, or vision and speech problems that can linger or be permanent. Subarachnoid hemorrhage most often occurs in people between ages 40 and 60 and is slightly more common in women than in men. People who have high blood pressure (see page 574) or diabetes (see page 889) are at increased risk.
Subarachnoid hemorrhage
In a subarachnoid hemorrhage, a ruptured blood vessel causes blood to leak into the space between the arachnoid and the pia mater, the middle and inner membranes of the three membranes that cover the brain. If enough blood puts pressure on brain tissue, it can cause permanent brain damage and be life-threatening.
Symptoms
The main symptom of a subarachnoid hemorrhage is a sudden, severe headache. A person also may have a stiff neck, be extremely sensitive to bright light (photophobia), or have strokelike symptoms including faintness, dizziness, confusion, drowsiness, nausea, and vomiting. A major hemorrhage can cause sudden loss of consciousness.
Diagnosis
For a person who is unconscious, the doctor will take steps to restore and maintain circulation and breathing. He or she will order a CT scan (see page 112) to determine if there is bleeding in the brain or if some other condition is causing the loss of consciousness. If the scan is normal, the doctor may recommend a lumbar puncture (see page 693), a procedure in which a hollow needle is inserted into the lower part of the spine to withdraw a sample of cerebrospinal fluid for microscopic examination to look for blood or inflammation.
Treatment