NMS Q&A Family Medicine

60 NMS Q&A Family Medicineminimal headache. In the latter case, the onset is usuallynot so rapid unless the cause is an embolic thrombus.Brain metastases are always a possibility in a long-timesmoker. However, the onset of symptoms is not likely tobe rapid. A TIA by the newest definition lasts less than 1 hour(it is less than 1 hour and even by the old rule, less than24 hours). Although migraine may be heralded by a neurologicaura (neurologic migraine), the aura is short lived,a matter of minutes to an hour, followed by neurologicrecovery and, only then, the headache.15. The answer is E, intravenous tissue plasminogenactivator. Acute use of warfarin or ticlopidine, althoughused in tertiary prevention of stroke, is not effective inacute stroke as clotting factors tend to be suppressed fortwo months after the acute phase of a stroke. Tissue plasminogenactivator will decrease the neurologic defect ifgiven within the first 3 hours after ischemic stroke, but itincreases the risk of hemorrhagic stroke development.Patients should initially be allowed nothing by mouthbecause of the frequency of associated swallowing difficultiesand risk for aspiration. Rapid reduction of BP iscontraindicated because this may drastically compromisecerebral blood flow. BP is lowered gradually so thathomeostatic mechanisms may readjust to the new systolicpressures. Low salt and low cholesterol are primary andsecondary prevention strategies but have no place in acutecare of stroke.ReferencesAminoff J . Nervous system . In: Tierney LM , McPhee SJ ,Papadakis MA , eds. Current Medical Diagnosis and Treatment ,43rd ed . New York : McGraw-Hill/Appleton & Lange ; 2004 :941 – 1000 .Coletta EM . Cerebrovascular disease and brain injury . In: RudyDR , Kurowski K , eds. Family Medicine: House Officer Series .Baltimore : Williams & Wilkins ; 1997 : 123 – 132 .Family Medicine Board Review 2009. May 3–9, 2009 .Solenski NJ . Transient ischemic attacks: Part I. Diagnosis andevaluation . Am Fam Physician . 2004 ; 69 : 1665 – 1674 .Solenski NJ . Transient ischemic attacks: Part II. Treatment . AmFam Physician. 2004 ; 69 : 1681 – 1688 .