K89 Transient cerebral ischaemia (ICD-10:G45.9)

Introduction

Transient cerebral ischemia, also known as a mini-stroke, is a condition characterized by a temporary disruption of blood flow to the brain. It is a significant medical concern as it can be a warning sign of an impending stroke.^[1] The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnosis and management of transient cerebral ischemia.

Codes

• ICPC-2 Code: K89 Transient cerebral ischaemia^[2]
• ICD-10 Code: G45.9 Transient cerebral ischaemic attack, unspecified^[3]

Symptoms

• Sudden weakness or numbness on one side of the body^[4]
• Difficulty speaking or understanding speech^[4]
• Loss of vision in one or both eyes^[4]
• Dizziness or loss of balance^[4]
• Severe headache^[4]

Causes

• Atherosclerosis: Build-up of plaque in the arteries leading to the brain^[5]
• Embolism: Blockage of blood flow due to a blood clot or other debris^[5]
• Small vessel disease: Narrowing or blockage of small blood vessels in the brain^[5]
• Cardiac arrhythmias: Irregular heart rhythms that can lead to blood clots^[5]

Diagnostic Steps

Medical History

• Gather information about the patient’s risk factors, such as hypertension, diabetes, smoking, and high cholesterol^[6]
• Assess the patient’s medical conditions, including history of stroke or heart disease^[6]
• Inquire about the duration and frequency of symptoms^[6]

Physical Examination

• Perform a thorough neurological examination, including assessment of strength, sensation, coordination, and reflexes^[7]
• Check blood pressure and heart rate^[7]
• Evaluate the carotid arteries for signs of plaque build-up or narrowing^[7]

Laboratory Tests

• Complete blood count (CBC) to assess for anemia or infection^[8]
• Lipid profile to evaluate cholesterol levels^[8]
• Blood glucose levels to screen for diabetes^[8]
• Coagulation studies to assess for clotting disorders^[8]

Diagnostic Imaging

• Magnetic resonance imaging (MRI) of the brain to visualize any abnormalities or signs of ischemia^[9]
• Computed tomography (CT) scan of the head to rule out other causes of symptoms, such as bleeding or tumors^[9]
• Carotid ultrasound to assess for plaque build-up or narrowing in the carotid arteries^[9]
• Transcranial Doppler ultrasound to evaluate blood flow in the brain^[9]

Other Tests

• Electrocardiogram (ECG) to assess for cardiac arrhythmias or other abnormalities^[10]
• Echocardiogram to evaluate the structure and function of the heart^[10]
• Holter monitor or event recorder to monitor heart rhythm over a longer period of time^[10]

Follow-up and Patient Education

• Schedule a follow-up appointment to review test results and discuss further management
• Educate the patient about the importance of lifestyle modifications and adherence to prescribed medications
• Provide information on recognizing and responding to symptoms of a stroke

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Transient cerebral ischemia:

1. Antiplatelet agents (e.g., Aspirin, Clopidogrel):
   • Cost: Aspirin is inexpensive (\<$10/month). Clopidogrel is $10-$100/month for generic.
   • Contraindications: Active bleeding, peptic ulcer disease.
   • Side effects: Upset stomach, bleeding.
   • Severe side effects: Severe bleeding, allergic reactions.
   • Drug interactions: NSAIDs, other blood thinners.
   • Warning: Risk of bleeding.
2. Anticoagulants (e.g., Warfarin, Apixaban):
   • Cost: Warfarin is inexpensive (\<$10/month). Apixaban is $300-$400/month.
   • Contraindications: Active bleeding, history of bleeding disorders.
   • Side effects: Increased risk of bleeding.
   • Severe side effects: Severe bleeding, allergic reactions.
   • Drug interactions: Many medications and herbal supplements.
   • Warning: Regular monitoring of blood clotting factors required.
3. Statins (e.g., Atorvastatin, Simvastatin, Rosuvastatin):
   • Cost: Generic versions can be $3-$50/month.
   • Contraindications: Active liver disease, hypersensitivity.
   • Side effects: Muscle pain, diarrhea, upset stomach.
   • Severe side effects: Rhabdomyolysis, liver damage.
   • Drug interactions: Grapefruit juice, other cholesterol-lowering agents.
   • Warning: Regular liver function tests required.
4. Angiotensin-converting enzyme (ACE) inhibitors (e.g., Ramipril, Lisinopril):
   • Cost: Generics can be $10-$50/month.
   • Contraindications: History of angioedema with ACE inhibitors, renal artery stenosis.
   • Side effects: Cough, elevated blood urea nitrogen.
   • Severe side effects: Angioedema, hyperkalemia.
   • Drug interactions: Potassium supplements, NSAIDs.
   • Warning: Monitoring of renal function and potassium is required.
5. Calcium channel blockers (e.g., Amlodipine, Nifedipine):
   • Cost: Generic versions are typically \<$30/month.
   • Contraindications: Severe hypotension, heart failure.
   • Side effects: Edema, dizziness, flushing.
   • Severe side effects: Heart block, worsening heart failure.
   • Drug interactions: Grapefruit juice, beta-blockers.
   • Warning: Should not be abruptly stopped.

Alternative Drugs:

• Cilostazol: A medication used specifically for claudication in peripheral vascular disease.
• Niacin: A vitamin B3 derivative that can help with cholesterol management.
• Ezetimibe: A cholesterol absorption inhibitor.
• Pentoxifylline: An alternative to cilostazol for claudication in peripheral vascular disease.
• Rivaroxaban: An anticoagulant used to reduce the risk of major cardiovascular events.

Surgical Procedures:

• Carotid endarterectomy: Surgical removal of plaque from the carotid artery. Cost: $15,000 to $50,000.
• Angioplasty and stent placement: A catheter is used to place a stent to open up narrowed arteries. Cost: $15,000 to $50,000.
• Coronary artery bypass surgery (CABG): Redirects blood around blocked or narrowed coronary arteries. Cost: $70,000 to $200,000.

Alternative Interventions

• Acupuncture: May help improve blood flow and reduce pain. Cost: $60-$120 per session.
• Chelation therapy: Controversial treatment involving the administration of chelating agents to remove heavy metals from the body. Cost: $75-$150 per session.
• Hyperbaric oxygen therapy: Involves breathing pure oxygen in a pressurized chamber to increase oxygen delivery to tissues. Cost: $200-$300 per session.
• Herbal supplements: Some herbs, such as garlic and ginkgo biloba, may have potential benefits for improving circulation. Cost: Varies depending on the specific supplement.

Lifestyle Interventions

• Smoking cessation: Cost: Varies depending on the method used (e.g., nicotine replacement therapy, medications, counseling).
• Regular exercise: Cost: Varies depending on the chosen activity (e.g., gym membership, equipment).
• Healthy diet: Cost: Varies depending on food choices and dietary restrictions.
• Weight management: Cost: Varies depending on the chosen weight loss program or method.
• Stress management: Cost: Varies depending on the chosen stress reduction techniques (e.g., yoga, meditation, therapy).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – K89 Transient cerebral ischaemia (ICD-10:G45.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Transient cerebral ischaemia effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Transient cerebral ischaemia. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Easton, J. D., Saver, J. L., Albers, G. W., Alberts, M. J., Chaturvedi, S., Feldmann, E., … & Sacco, R. L. (2009). Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: the American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke, 40(6), 2276-2293.
2. WONCA International Classification Committee. (1998). ICPC-2: International classification of primary care. Oxford University Press, USA.
3. World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems: tenth revision. World Health Organization.
4. Nadarajan, V., Perry, R. J., Johnson, J., & Werring, D. J. (2014). Transient ischaemic attacks: mimics and chameleons. Practical neurology, 14(1), 23-31.
5. Hankey, G. J. (2017). Stroke. The Lancet, 389(10069), 641-654.
6. Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., … & Vinters, H. V. (2013). An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44(7), 2064-2089.
7. Edlow, J. A., & Kim, S. (2012). Transient ischemic attack: an evidence-based update. Emergency Medicine Practice, 14(1), 1-26.
8. Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., … & Wilson, J. A. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7), 2160-2236.
9. Wintermark, M., Sanelli, P. C., Albers, G. W., Bello, J. A., Derdeyn, C. P., Hetts, S. W., … & Meltzer, C. C. (2013). Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery. Journal of the American College of Radiology, 10(11), 828-832.
10. Furie, K. L., Kasner, S. E., Adams, R. J., Albers, G. W., Bush, R. L., Fagan, S. C., … & Wentworth, D. (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1), 227-276.