The implications of a TIA are the same as that of a cerebrovascular accident (CVA or stroke): Wait 3 months - Studies indicate that patients that have had a stroke within the last 3 months are at greater risk for major cardiovascular events and have a higher 30-day mortality rate. Therefore, elective surgery should be delayed for 3 months after the stroke where feasible. High risk for another stroke - If a patient has had a stroke, they are far more likely than the general population to experience another. The highest risk is within the first month. Choice of anesthetic - Autoregulation is impaired in the days following a stroke - so even modest changes in blood pressure could have drastic affects on cerebral perfusion. It is predicted that this lasts for 1-3 months following a stroke. Furthermore, ischemic tissue affected by a stroke has undergone inflammatory processes and is especially susceptible to further damage by the hemodynamic changes experienced during anesthesia. Clinical trials are ongoing to establish a particular anesthetic technique as the preferred or safest. For the present, safeguard against drastic changes in hemodynamic parameters. Preoperatively assess and document weakness/residual affects of the stroke. High risk surgeries - The highest risk surgeries for a patient to experience a stroke intraoperatively are cardiac, carotid, and neurological surgeries.
This is essentially a stroke, and is also characterized by the symptoms of a stroke. However, differing from a full stroke, the symptoms of a TIA resolve within 24 hours. Symptoms - characterized by a neurological deficit which follows an ischemic or hemorrhagic problem. Ischemic events occur as a result of a embolism or thrombosis. Trauma, vascular malformation, and coagulopathy are the primary culprits for hemorrhagic problems. The vast majority of strokes are classified as ischemic. Very Common - 3% of adults in the United States have experienced a stroke. Inherited risk factors - include age, prior history of a CVA, family history of a CVA, black race, male, and sickle cell disease. Modifiable risk factors - include hypertension, tobacco use, diabetes, carotid artery disease, atrial fibrillation, heart failure, high cholesterol, obesity, and sedentary lifestyle.
