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Do Not Diagnose Tia in 4 Types of Patients
O P Kapoor
 

Transient Ischaemic Attacks (TIAs) are extremely common in private practice. After diagnosing such an attack, if the patient is put on Aspirin alone (other drugs can also be added), the chances of the patient developing a permanent neurological deficit are remote.

Then, what is the role of the family physician?

Many attacks (TIAs) subside in 5-10 minutes. In such cases, the family physician, does not get any credit for the recovery. Even after starting treatment, often the patient’s family may not be impressed with an assurance that the patient will not develop a permanent neurological deficit in future. This is especially so, when some of the patients’ relatives may have little faith in the treatment prescribed. Besides, the patient may not have the motivation to continue the treatment for a lifetime.

In this communication, I would like to advise the family physicians as follows:

Do not Diagnose Tia if

  1. The patient is young.
  2. The patient experienced headache during the attack.
  3. The patient developed unconsciousness during the attack.
  4. The attack has lasted for more than 5 to 10 minutes.
 

SURGERY VERSUS CONSERVATIVE TREATMENT FOR INTRACEREBRAL HAEMORRHAGE - IS THERE AN END TO THE LONG CONTROVERSY?

Is surgery for spontaneous intracerebral haemorrhage beneficial compared with conservative treatment?

Yet conclusions of whether surgery is beneficial over conservative treatment remain controversial. The reason is that these studies had only weak analytical power because they were small and limited to local areas.

Besides appropriate selection of subgroups of patients for surgery, it is important to improve operative techniques to obtain good surgical results. The results of STICH show that there is more likely to be a favourable outcome of surgery, mainly craniotomy, if the haematoma is 1 cm or less from the cortical surface. Endoscopic surgery is one of the methods expected to be effective for treatment of deep haematoma.

Takahiro Nakano, Hiroki Ohkuma, Lancet, 2005; 365 : 361.

ETANERCEPT PLUS STANDARD THERAPY FOR WEGENER’S GRANULOMATOSIS

Etanercept is not effective in preventing disease flares in patients with Wegener’s granulomatosis.

N Engl J Med 2005; 352 : 351.