Minor stroke captured on video Watch as it happen

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About this video

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# 🧠 **Minor Stroke (TIA / Mild Ischemic Stroke)**

A **minor stroke** means an **ischemic stroke with mild neurological deficits** (often **NIHSS ≤ 5**) OR a **Transient Ischemic Attack (TIA)** where symptoms resolve within **24 hours**.

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# 1️⃣ **Definition**

* **Minor Stroke:** Small ischemic injury causing mild, non-disabling neurological deficit (speech difficulty, limb weakness, facial droop, gait imbalance, visual loss).
* **Transient Ischemic Attack (TIA):** A brief episode of neurological dysfunction caused by focal brain ischemia **without infarction**.

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# 2️⃣ **Pathophysiology**

* **Reduced cerebral blood flow** from vascular occlusion (thrombus or embolus).
* Leads to:

* **Penumbra**: salvageable tissue with reduced perfusion.
* **Core infarct**: irreversible damage if perfusion not restored.
* Mechanisms:

* **Atherosclerosis** → carotid plaque rupture → thrombus.
* **Cardioembolism** (AF, valvular disease).
* **Small vessel (lacunar)** disease (HTN, diabetes).

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# 3️⃣ **Causes & Triggers**

* **Hypertension** (most common risk factor)
* **Diabetes**
* **Atrial fibrillation**
* **Hyperlipidemia**
* **Carotid stenosis**
* **Smoking**
* **Obesity**
* **Sedentary lifestyle**
* **Oral contraceptives**, pregnancy
* **Cocaine, amphetamines**

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# 4️⃣ **Clinical Features**

Symptoms depend on region affected:

### **Cortical (MCA)**

* Facial droop
* Arm weakness
* Aphasia (left)
* Neglect (right)

### **Brainstem**

* Diplopia
* Dysarthria
* Ataxia

### **Cerebellar**

* Vertigo
* Imbalance
* Nystagmus

### **TIA**

* Symptoms resolve within minutes–hours.

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# 5️⃣ **Investigations**

## **Immediate**

* **CT brain (non-contrast)** – rule out hemorrhage.
* **MRI DWI** – detects small infarcts.
* **Blood tests**: CBC, RBS, lipids, INR, renal function.
* **ECG** – AF detection.

## **Further evaluation**

* **Carotid Doppler** – stenosis.
* **Echocardiography** – cardioembolic source.
* **Holter** – paroxysmal AF.

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# 6️⃣ **Differential Diagnosis**

* Migraine aura
* Seizure with post-ictal paralysis (Todd's)
* Hypoglycemia
* Demyelinating disease
* Vestibular neuritis
* Functional neurological disorder

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# 7️⃣ **Management (Stepwise)**

## ⭐ **Immediate Emergency Steps**

1. **ABC stabilization**
2. **Check glucose** → Correct hypoglycemia.
3. **CT scan** immediately.

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## ⭐ **Acute Treatment**

### **If within window (≤ 4.5 hours):**

* **IV Thrombolysis (Alteplase)**

* Dose: **0.9 mg/kg** (max 90 mg)

* 10% bolus in 1 min
* Rest infused over 60 min

### **If large vessel occlusion and NIHSS mild but disabling:**

* **Mechanical thrombectomy** within **6–24 hours** (based on perfusion imaging).

### **If not eligible for thrombolysis:**

* **Dual antiplatelet therapy (DAPT)**

* **Aspirin 81–325 mg** + **Clopidogrel 75 mg**
* **Duration:** 21 days → then single antiplatelet lifelong.

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## ⭐ **Secondary Prevention**

### **Antiplatelets**

* Aspirin 81–325 mg daily
* OR Clopidogrel 75 mg

### **Statins**

* **High-intensity statin:**

* Atorvastatin **40–80 mg**
* Rosuvastatin **20–40 mg**

### **Blood pressure control**

* Goal: **<130/80**

### **Diabetes control**

* HbA1c target: **<7%**

### **Anticoagulation**

If stroke due to **atrial fibrillation**:

* Apixaban 5 mg BID
* Dabigatran 110–150 mg BID
* Rivaroxaban 20 mg daily
(Timing: usually 3–14 days post-stroke depending on size)

### **Lifestyle**

* Smoking cessation
* Weight loss
* Exercise 150 min/week
* DASH/Mediterranean diet

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# 8️⃣ **Complications**

* Recurrent stroke (highest risk in first **48 hours**)
* Long-term disability
* Cognitive decline

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# 9️⃣ **Prognosis**

* Minor stroke has **excellent recovery** if treated early.
* Risk of major stroke after TIA is **10% within 90 days** (half occur in first 48 hours).

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# 🔟 **Patient Counselling**

* Seek emergency care if **any new weakness, slurred speech, facial droop** returns.
* Importance of **adherence to medications**.
* Control BP, sugar, cholesterol strictly.
* Avoid smoking, alcohol excess, and heavy salt.

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