Transient ischemic attack (TIA): causes, symptoms, treatment
Transient ischemic attack (TIA) is one of the varieties of acute circulatory disorders in the brain tissue, which appears cerebral and focal signs of brain damage and lasts from a few minutes up to 24 hours. If the symptoms persist for more than a specified time, such a state should be regarded already as
Causes and risk factors of TIA
Often passing ischemic attacks occur in patients with
The essence of the disease
There are several mechanisms of development of acute disorders of cerebral circulation and in particular TIA. But the most common is the following.
And microemboli of atheromatous masses that form in the carotid and vertebral arteries (they are the result of disintegration of atherosclerotic plaques) blood can move into the blood vessels of smaller caliber where and cause clogging of the arteries. Most often suffer the ultimate cortical branches of the arterial vessels. In addition to the overlap of the lumen of the artery, they cause irritation and spasm of the vascular walls. Since themselves such masses can rarely cause complete cessation of blood circulation distal to the site of localization, the second mechanism plays a major role in the development of symptoms of TIA.
These platelet and atheromatous mass in its structure, are very soft and will quickly succumb to dissolution. After that spasm of the artery is eliminated and the blood flow in this area of the brain normalizerbase. All the symptoms are. Also, these microemboli can have a cardiogenic origin or be a consequence of the problems in the coagulation of blood.
The process itself lasts only a few seconds or minutes, but pathological symptoms sometimes last up to 24 hours. This is due to the edema of the vascular wall due to its irritation, which takes place for several hours after the acute period.
But, unfortunately, not always the development of the disease is favorable. If the dissolution of blood clots and vascular spasm persists independently for 4-7 minutes, but in neurons, which are in conditions of hypoxia, irreversible changes, and they die. Developing a stroke. But, fortunately, these strokes have a relatively favorable prognosis, as never extensive.
The symptoms of TIA
The signs often become apparent focal nerve signs. Much less likely to develop cerebral symptoms such as headache, vertigo, nausea, with retching, disturbance of consciousness.
Symptoms of TIA depend on the localization of atherosclerotic plaques in the carotid or vertebral-basilar vascular bed.
TIAS in the vertebral-basilar vascular pool
This TIA are common and constitute up to 70% carryover of ischemicattacks.
The symptoms of TIA:
- bouts of dizziness system;
- vegetative-vascular disorders;
- noise and ringing in the head and in the ears;
- headaches expander character in the back of the head;
- prolonged bouts of hiccups;
- pallor of the skin;
- increased paroobrazovaniya;
- visual disturbances – dots, zigzags before the eyes, loss of visual fields, double vision, fog before the eyes;
- signs of bulbar syndrome (impaired swallowing, pronunciation of words, loss of voice);
- violation of statics and coordination;
- drop-attacks – bouts of sudden falling without loss of consciousness.
TIA in the carotid vascular pool
Appears mainly focal neurological symptoms, most often it is sensory disorders. Sometimes the symptoms are so minimal that the patient doesn't even understand what his body is something wrong.
The symptoms of TIA:
- numbness in certain areas of the body, most often General relativity one limb, but may be the type of hemianesthesia (lose arms and legs on one side of the body);
- the development of motor disturbances in the form of monoparesis or hemiparesis (loss of one limb or arm and leg on one side of the body);
- if the lesion is localized in the left hemisphere, develop problems with speech, aphasia, cortical dysarthria;
- blindness in one eye.
The duration and reversibility of symptoms of TIA different from a few seconds up to 24 hours. But, nevertheless, the exact diagnosis can only be made after some time. The fact is that with TIA according to additional research methods (MRI and CT), no pathological foci were found. If this happens then we should talk about stroke even in the case where all signs disappeared during the first days after onset. In medicine there is a special term for this type of violation of blood circulation in brain tissue – a “small stroke”.
Video transmission and signs of a stroke:
Depending on the dynamics of the disease distinguish 3 severity of transient ischemic attack:
- Easy – focal neurological symptoms are present for up to 10 minutes, pass independently, a consequence no remains.
- Moderate severity signs can last from 10 minutes to several hours, are independently or under the influence of therapy without consequences.
- Severe neurological symptoms were present from several hours to 1 day, is under the influence of specific therapy, but after the acute period there are consequences in the form of small neurological symptoms, which does not affect the quality of life, but revealed during the inspectionby a neurologist.
Depending on the frequency of attacks are distinguished:
- rare TIA – not more than 1-2 times per year;
- with medium frequency – 3-6 times a year;
- frequent – 1 time during the month or more often.
Diagnosis of transient ischemic attack presents some difficulties. First, it is not always people pay attention to the symptoms of the disorders, considering them to be normal. Second, the differential diagnosis between ischemic stroke and TIA in the early hours is a very big difficulties, because the symptoms are very similar, and imaging may not yet be changes, as a rule, when a stroke they are clearly visible only in 2-3 days from the development of pathology.
For diagnostic use:
- detailed objective examination of the patient, collecting complaints and study of the history of the disease, identify risk factors for the development of TIA;
- full spectrum of laboratory tests of blood and urine, which must include lipidogramu, the study of the coagulation abilities of the blood, biochemical analysis of blood;
- ECG and heart ultrasound for the detection of cardiopathology;
- Ultrasound of vessels of head and neck;
- magnetic resonance or computed tomography of the brain;
Principles of treatment
First we need to determine whether transient ischemic attack treatment. Many experts argue that treatment of TIA is not needed, because all the signs are themselves. This is true, but there are 2 controversial moment.
First. TIA is not an independent disease, and consequence of the primary pathology. Because all therapeutic measures should be directed to therapy triggered the violation of the diseases, as well as primary and secondary prevention of acute disorders of cerebral circulation.
Second. Treatment of TIA should be conducted for all medical protocols for the management of patients with ischemic stroke, as has been said, to distinguish between these two States in the first few hours is simply impossible.
The main therapeutic measures:
- compulsory hospitalization in a specialized neurological Department;
- specific thrombolytic therapy (administration of drugs, which are able to dissolve already existing clots), used in the first 6 hours from the onset of the disease in patients who still suspect a stroke;
- anticoagulant therapy – the introduction of drugs that thin the blood and prevent blood clots (heparin, enoxaparin, dalteparin, fraxiparin, etc.);
- medications that normalize blood pressure increasing (beta-blockers, ACE inhibitors, Sartana, diuretics, blockerscalcium channels);
- antiplatelet agents that prevent platelets from sticking together among themselves and the formation of blood clots (clopidogrel, aspirin);
- drugs which possess neuroprotective abilities – protect nerve cells from damage, increase their resistance to hypoxia;
- antiarrhythmic drugs in heart rhythm disorders;
- medicines that reduce the level of cholesterol in the blood statins (atorvastatin, rosuvastatin, simvastatin, etc.);
- symptomatic therapy and a tonic.
Surgical treatment may be assigned in atherosclerotic lesions of the extracranial vessels, particularly the carotid. There are surgical intervention of three types:
- carotid endarterectomy when the atherosclerotic plaque is removed from the lumen of the vessel together with the inner part of its walls;
- stenting of narrowed arteries;
- prosthetics – the replacement of the affected artery autograft.
Prognosis and prevention
The prognosis of transient ischemic attack favorable, but each episode is increasing the risk of ischemic stroke, because it is necessary to take all measures for prevention of vascular catastrophe in the brain.
Basic preventive measures:
- correction of risk factors of TIA;
- healthy lifestyle;
- proper nutrition;
- normalization of body weight;
- elimination of harmful habits;
- treatment of comorbidities – hypertension, diabetes, arrhythmias, atherosclerosis, etc.;
- sufficient physical activity;
- welcome krovanistaya drugs to people at risk;
- surgical correction narrowing of the arteries.
Video transmission about ischemic attack – a harbinger of stroke:
Doing conclusion, it is necessary to remember that, while transient ischemic attack and does not bear a direct threat to human life, but it is a warning of the body that in the future it can happen. Because in any case it is impossible to ignore the condition and must take all measures to prevent disaster.