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Transient ischemic attack
Last reviewed: 23.04.2024
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Transient ischemic attack (TIA) - focal ischemia of the brain, manifested by sudden neurologic symptoms lasting less than 1 hour. Diagnosis is made on the basis of clinical symptoms. Carotid endarterectomy, antiplatelet drugs and warfarin reduce the risk of stroke in certain types of transient ischemic attack.
Transient ischemic attack is similar to ischemic stroke, except that symptoms last less than 1 hour; most transient ischemic attacks last less than 5 minutes. Although the definition of "transient ischemic attack" is clinical and is currently being revised, the occurrence of a heart attack is unlikely if the violations are resolved within 1 hour. Transient ischemic attacks occur more often in elderly and middle-aged people and significantly increase the risk of stroke in the next 24 hours after the attack.
Causes of the transient ischemic attack
Causes of transient ischemic attacks
Transient ischemic attacks are mainly due to cerebral embolism, the source of which is atherosclerotic plaques and ulcerated plaques in the carotid or vertebral arteries, however, most causes of ischemic stroke can also lead to transient ischemic attack. Sometimes transient ischemic attacks develop against a background of hypoperfusion due to severe hypoxemia and hypoxygenation of blood (eg, with severe anemia, carbon monoxide poisoning) or due to increased blood viscosity (with polycythemia), especially if the cerebral arteries were initially stenosed. Ischemia does not develop with systemic hypotension, except in cases of its combination with severe arterial stenosis, because due to autoregulation cerebral blood flow is always maintained at the desired level within a wide range of systemic blood pressure values.
With the syndrome of subclavian stealing, the stenosis of the subclavian artery is proximal to the site of the vertebral artery's spasm, resulting in blood flowing actively into the subclavian artery in situations of increased blood supply to the hand (physical work), stealing the vertebrobasilar pool with the development of symptoms of ischemia.
Sometimes transient ischemic attacks are observed in children with severe cardiovascular diseases, which are accompanied by high hematocrit and frequent embolisms.
[Symptoms of the transient ischemic attack
Symptoms of transient ischemic attacks
Neurological disorders are similar to those in stroke. In the defeat of the eye artery, transient monocular blindness ( transient blindness ) can develop which usually lasts less than 5 minutes. Symptoms occur suddenly, last from 2 to 30 minutes and result in a complete regression of neurological symptoms. The frequency of transient ischemic attacks can range from 2-3 episodes in one day to 2-3 episodes for several years. The symptomatology is stereotyped for repeated transient ischemic attacks in the pool of carotid arteries and can vary with the development of consecutive transient ischemic attacks in the basin of vertebrobasilar arteries.
Diagnostics of the transient ischemic attack
Diagnosis of transient ischemic attacks
The diagnosis is put retrospectively on the basis of complete regression within 1 h of sudden appearance of neurologic symptoms. Isolated peripheral paralysis of the facial nerve, loss of consciousness or impaired consciousness do not fit into the clinical picture of transient ischemic attacks. Transient ischemic attacks should be differentiated from diseases accompanied by similar symptoms (eg, hypoglycemia, migraine aura, Todd's paralysis). Proceeding from the fact that on the basis of clinical symptoms to exclude ischemic infarction, a small hemorrhage and lesions with mass effect is impossible, it is necessary to conduct neurovisualization studies. CT is the method of choice for avoiding hemorrhage. MRI reveals the developing infact of the first few hours; CT can not detect a heart attack within the first 24 hours. Diffusion-weighted MRI allows to reliably exclude infarction in patients with an alleged transient ischemic attack, the only drawback of the method is its limited availability.
The diagnostic algorithm for transient ischemic attacks is the same as for ischemic stroke. The search for probable causes of cerebral circulation disorders is aimed at revealing the stenosis of carotid arteries, atrial fibrillation or sources of cardiogenic emboli, blood diseases. Additionally, all possible risk factors for stroke are evaluated. Remembering the increased risk of ischemic stroke in a patient with transient ischemic attack, the examination is performed quickly, usually during inpatient treatment.
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Treatment of the transient ischemic attack
Treatment of transient ischemic attacks
Treatment of transient ischemic attack is aimed at the prevention of stroke; antiplatelet drugs are used. Carotid endarterectomy, arterial angioplasty and stenting are effective first of all in patients without neurological defects after transient ischemic attack, but with a continuing high risk of stroke. If there is a source of cardiogenic embolism, warfarin is prescribed. It should not be forgotten that controlling controlled risk factors can prevent stroke.
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