Clinic of transient ischemic attack. Diagnosis "TIA", transient ischemic attack: symptoms, causes, treatment

Main points:

signs

The symptoms of a transient ischemic attack depend on which vessels are affected and which area of ​​the brain is damaged. If the damage is localized in the carotid pool, that is, if the carotid arteries are damaged, then the person’s coordination of movements, speech, and vision are disturbed (temporary blindness or decreased vision in one eye is possible). Paresis also develops, and any one area of ​​the body or muscle group is predominantly affected, for example, paresis of the hand or foot, or fingers. The skin of the face, hands and feet loses sensitivity. In some cases, the sensitivity is reduced on half of the body.

With ischemia in the vertebrobasilar basin (in the basin of the vertebral and basilar arteries), a person develops dizziness. headache in the occiput. Speech, memory, coordination of movements are disturbed, dysphagia develops. In the eyes doubles, darkens, vision falls, hearing worsens. Perhaps numbness around the mouth or paresis of half of the face.

Description

Unfortunately, transient ischemic attack in 60% of cases is not recognized in time. This is due to the fact that many often underestimate the severity of symptoms and do not seek medical attention. In addition, this condition often occurs in a dream, and since it has no consequences, patients do not even know about it. That is why it is impossible to accurately determine the incidence rate. Doctors estimate that transient ischemic attacks occur in 12-35% of people over 50 years of age.

The cause of a transient ischemic attack is a restriction of the blood supply to a part of the brain due to blockage of a vessel supplying blood to the brain. This may be due to a blood clot or atherosclerotic plaque. In extremely rare cases, a transient ischemic attack can be caused by hemorrhage. However, in this state, blood circulation is restored quite quickly.

Thromboembolism can occur when:

• artificial heart valve;
• mitral stenosis with atrial fibrillation;
• sick sinus syndrome;
• infective endocarditis;
• acute period of myocardial infarction;
• atrial fibrillation;
• dilated cardiomyopathy;
• atrial myxoma (a benign tumor in the upper left or right side of the heart that has grown into this organ);
• thrombus in the left ventricle or left atrium.

However, the development of this condition is also possible with non-closure of the foramen ovale, non-bacterial thrombotic endocarditis, congestive heart failure, mitral valve calcification, mitral valve prolapse, coagulopathy, angiopathy, especially with anomalies in the development of the carotid and vertebral arteries.

Risk factors for transient ischemic attack:

Despite the fact that the prognosis for TIA is favorable, it is a dangerous harbinger of a stroke. There is evidence that within a month after TIA, a stroke develops in 4-8% of patients, during the first year - in 12%, over the next five years - in 29%.

Diagnostics

With a transient ischemic attack, you need to consult a cardiologist, angiologist and an ophthalmologist. You may also need to be tested by a medical psychologist.

It is also necessary to pass a general and biochemical blood test, a general urine test. blood for coagulogram.

Treatment

Treatment usually takes place in a hospital. The patient is allowed to go home only if he has the opportunity, in case of a repeated attack, to be immediately hospitalized in a hospital. Those who have had a transient ischemic attack are prescribed antiplatelet (blood thinning) agents, vasodilators, drugs to lower blood cholesterol levels. If necessary, antihypertensive agents are also prescribed.

With an increase in the frequency and duration of transient ischemic attacks, they may resort to surgical treatment - they remove fat that squeezes the artery and its damaged area or do angioplasty.

A good effect in the treatment gives balneotherapy - coniferous, radon, salt. Pearl baths, circular showers, wet wipes.

Physiotherapy is also often prescribed - electrophoresis, an alternating magnetic field, microwave therapy.

Prevention

Prevention is aimed at eliminating risk factors. That is, you need to exercise, eat right. limit the intake of salty and fatty, monitor weight. do not abuse alcohol. quit smoking.

It is also necessary, if necessary, to take drugs that improve the rheological properties of the blood (“thinning” the blood).

Transient ischemic attack - a harbinger of a stroke

The term TIA (transient ischemic attack) refers to ischemic stroke. Symptoms of TIA last no more than 1 hour. If the clinical signs of an attack do not go away within a day, then doctors diagnose a stroke. TIA (and popularly, just a microstroke) seems to be a signal for a person that a catastrophe is brewing in the brain, so this condition must be taken very seriously.

Causes of TIA

The cause of the manifestation of TIA is a lack of oxygen in one of the areas of the brain. Ischemia (oxygen starvation) develops, and if measures are not taken, a stroke may occur. If ischemia occurs in the area of ​​the brain responsible for speech, then a person’s speech will be disturbed, if the “visual” area, then visual impairment will be observed. If ischemia occurs in the region of the vestibular region of the brain, then the patient complains of severe dizziness and nausea.

Clinical manifestations

Depending on the focus of ischemia, the clinical manifestations will be different. Most often, the patient is worried about severe dizziness, nausea, vomiting, double vision, severe pain in the back of the head, fear of light, impaired coordination. Focal symptoms include paresis of one or two limbs, decreased sensitivity and numbness in the limbs, impaired speech function, its slowdown. There is a so-called “scissors” symptom, when the right (left) part of the hemisphere of the brain is affected, and paresis occurs in the opposite limb. On the first day of TIA, a stroke occurs in about 10% of patients, and after 3 months, in another 20%. About 30% of patients, within 5 years after TIA, suffer a cerebral stroke, its severity depends on the frequency of ischemic attack.

Diagnostics

Most often, it is very difficult to establish the diagnosis of TIA, since before the arrival of a doctor, its symptoms disappear abruptly. However, one should not refuse hospitalization, since if the cause of the attack was a blockage of one of the vessels, then a stroke will certainly develop within a few hours or days. In the hospital, the victim will be diagnosed and urgent measures will be taken. It is optimal to arrive at the hospital within 3 hours after the first TIA.

In the hospital, the patient will undergo an ECG, magnetic resonance imaging, vascular angiography, Doppler ultrasound. Treatment should be carried out only in the hospital, no later than 2 days after the initial manifestations of TIA. Regardless of when the attack occurred and how it manifested itself, people over 45 years of age, or those who have had at least one TIA attack in the last 5 years, are subject to mandatory hospitalization.

According to statistics, TIA is considered a very dangerous risk factor for ischemic stroke. Doctors - neurologists say that people who have had a TIA are at high risk of developing a stroke. Within 30 days, the danger reaches 4-8%, during the year it increases to 12-13%, and after another 5 years it reaches 24-29%. According to studies, the risk of stroke in people who had an attack increased by 13-16 times during the first year and by about 7 times over the next 5 years. These indicators do not show the full difference in the prognosis of individual groups. Patients who have had TIA of the cerebral hemispheres, and at the same time the stenosis of the internal carotid artery was more than 70%, have a risk of more than 40% of developing a stroke within 2 years.

It is very important to correctly and quickly diagnose TIA. As mentioned above, the risk of stroke exceeds the threshold of more than 5% during the first month. The early development of ischemic stroke is significantly increased in those people who have had a TIA recently, or an attack that has recurred several times in the last 5 years. The doctor needs to clarify with the patient how the TIA proceeded, what clinical manifestations contributed to it, whether there were speech disorders or a decrease in sensitivity in the limbs, whether this was manifested by numbness of the fingers. One of the important clinical signs associated with the presence of carotid atherosclerosis is short-term blindness of the ipsilateral eye (from Latin amauros fugax).

It is believed that stenosis of the carotid artery is the very first sign of the development of cerebral ischemia, which is manifested by an ischemic attack. A neurologist should definitely auscultate the vessels of the neck in people over 40 years old. If carotid arteries are affected by atherosclerosis, systolic murmur is heard in 70% of cases, which is already a sign of vascular damage. More than a quarter of a century ago, Academician Pokrovsky singled out 4 degrees of vascular damage and clinical manifestations of cerebral ischemia. This classification differed from others in that it included the first group of cerebral vascular insufficiency - asymptomatic. This group included patients who did not have any clinical manifestations of cerebral vascular insufficiency. However, these patients had vascular lesions, in the form of a systolic murmur on auscultation of the neck vessels and in the difference in arterial systolic pressure between the two arms.

Transient ischemic attack: causes, signs, diagnosis, therapy, prognosis

Transient ischemic attack (TIA) was formerly known as dynamic or transient brain disorder blood circulation. which, in general, well expressed its essence. Neurologists know that if a TIA does not go away within a day, then the patient should be given a different diagnosis - ischemic stroke .

People without medical education, turning to search engines or otherwise trying to find reliable sources describing this type of cerebral hemodynamic disorder, may call TIA a transit or transistor ischemic attack. Well, they can be understood, diagnoses are sometimes so tricky and incomprehensible that you break your tongue. But if we talk about the names of TIA, then, in addition to the above, it is also called cerebral or transient ischemic attack .

In its manifestations, TIA is very similar to ischemic stroke, but for that it is an attack, to attack only for a certain short time. after which there is no trace of cerebral and focal symptoms. Such a favorable course of a transient ischemic attack is due to the fact that it is accompanied by microscopic damage to the nervous tissue. which subsequently do not affect on human life.

difference between TIA and ischemic stroke

Causes of transient ischemia

The factors that caused a violation of blood flow in some part of the brain are mainly microemboli. become the causes of transient ischemic attack:

• Progressive atherosclerotic process (vasoconstriction, decaying atheromatous plaques and cholesterol crystals can be carried with blood flow into smaller vessels in diameter, contribute to their thrombosis, resulting in ischemia and microscopic foci of tissue necrosis);
• Thromboembolism resulting from many heart diseases (arrhythmias, valvular defects, myocardial infarction, endocarditis, congestive heart failure, aortic coarctation, AV blockade, and even atrial myxoma);
• Sudden hypotension. inherent in Takayasu's disease;
• Buerger's disease (obliterating endarteritis);
• Osteochondrosis of the cervical spine with compression and angiospasm, resulting in vertebrobasilar insufficiency (ischemia in the basin of the main and vertebral arteries);
• Coagulopathy, angiopathy and blood loss. Microemboli in the form of aggregates of erythrocytes and platelet conglomerates, moving with the blood flow, they can stop in a small arterial vessel, which they could not overcome, since they turned out to be larger in size. The result is occlusion of the vessel and ischemia;
• Migraine.

In addition, the eternal prerequisites (or satellites?) of any vascular pathology contribute well to the onset of cerebral ischemic attack: arterial hypertension. diabetes mellitus, cholesterolemia. bad habits in the form of drinking and smoking, obesity and physical inactivity.

Signs of a TIA

Neurological symptoms of an ischemic attack of the brain, as a rule, depend on the site of circulatory disorders (the pool of the main and vertebral arteries or the carotid pool). The identified local neurological symptoms help to understand in which particular arterial basin the violation occurred.

For transient ischemic attack in the area vertebro —basilar basin characterized by symptoms such as:

If TIA affected carotid pool. then the manifestations will be expressed by a disorder of sensitivity, speech disorders, numbness with impaired mobility of the arm or leg (monoparesis) or one side of the body (hemiparesis). In addition, the clinical picture can be supplemented by apathy, stupor, and drowsiness.

Sometimes patients have a severe headache with the appearance of meningeal symptoms. Such a depressing picture can change as quickly as it began, which does not give any reason to calm down, since TIA can attack the patient's arterial vessels in the very near future. More than 10% of patients develop ischemic stroke in the first month and in almost 20% within a year after a transient ischemic attack.

Obviously, the TIA clinic is unpredictable, and focal neurological symptoms may disappear even before the patient is taken to the hospital, so anamnestic and objective data are very important for the doctor.

Diagnostic measures

Of course, it is very difficult for an outpatient with TIA to go through all the examinations provided for in the protocol, and besides, there is a risk of a second attack, so only those who can be taken to the hospital immediately in case of neurological symptoms can stay at home. However, persons over 45 years of age are deprived of such a right and are hospitalized without fail.

Diagnosis of transient ischemic attacks is quite difficult, since the symptoms disappear, but the causes that caused the cerebrovascular accident continue to remain. They need to be clarified, since the likelihood of ischemic stroke in such patients remains high, so patients who have had a transient ischemic attack need an in-depth examination according to a scheme that includes:

• Palpatory and auscultatory examination of the arterial vessels of the neck and extremities with the measurement of blood pressure in both arms (angiological examination);
• Detailed blood test (general);
• A complex of biochemical tests with the obligatory calculation of the lipid spectrum and the coefficient of atherogenicity;
• Study of the hemostasis system (coagulogram);
• Electroencephalogram (EEG);
• REG of head vessels;
• Doppler ultrasound of the cervical and cerebral arteries;
• Magnetic resonance angiography;
• CT scan.

Such an examination should be carried out by all people who have had a TIA at least once, due to the fact that focal and / or cerebral symptoms that characterize a transient ischemic attack and occur suddenly, usually do not linger for a long time and do not give consequences. Yes, and an attack can happen only once or twice in a lifetime, so patients often do not attach much importance to such a short-term health disorder at all and do not run to the clinic for advice. As a rule, only patients who are in the hospital are examined, and therefore it is difficult to talk about the prevalence of cerebral ischemic attack.

Differential Diagnosis

The complexity of diagnosing a transient ischemic attack also lies in the fact that many diseases, having neurological disorders, are very similar to TIA, for example:

1. migraine with aura gives similar symptoms in the form of speech or visual disturbances and hemiparesis;
2. Epilepsy. an attack of which can result in a disorder of sensitivity and motor activity, and even tends to sleep;
3. Transient global amnesia. characterized by short-term memory disorders;
4. Diabetes can “afford” any symptomatology, where TIA is no exception;
5. The initial manifestations of multiple sclerosis mimic well a transient ischemic attack. which confuse doctors with such TIA-like signs of neurological pathology;
6. Meniere's disease. flowing with nausea, vomiting and dizziness, very similar to TIA.

Does a transient ischemic attack require treatment?

Many experts are of the opinion that TIA itself does not require treatment, except perhaps while the patient is in a hospital bed. However, given that transient ischemia is caused by disease causes, it is still necessary to treat them so that there is no ischemic attack or, God forbid, ischemic stroke.

The fight against bad cholesterol at its high levels is carried out by prescribing statins so that cholesterol crystals do not ply through the bloodstream;

Increased sympathetic tone is reduced by the use of adrenoblockers (alpha and beta), well, and its unacceptable decrease is successfully stimulated by the appointment of tinctures such as pantocrine, ginseng, caffeine and lure. Recommend preparations containing calcium and vitamin C.

With increased work of the parasympathetic department, drugs with belladonna, vitamin B6 and antihistamines are used, but the weakness of the parasympathetic tone is leveled by potassium-containing drugs and small doses of insulin.

It is believed that in order to improve the functioning of the autonomic nervous system, it is advisable to act on both of its departments using grandaxine and ergotamine preparations.

Arterial hypertension, which greatly contributes to the onset of an ischemic attack, needs long-term treatment, which involves the use of beta-blockers, calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors. The leading role belongs to drugs that improve venous blood flow and metabolic processes occurring in the brain tissue. The well-known cavinton (vinpocetine) or xanthinol nicotinate (theonicol) are very successfully used to treat arterial hypertension, and, consequently, reduce the risk of cerebral ischemia.

With hypotension of cerebral vessels (REG conclusion), venotonic drugs (venoruton, troxevasin, anavenol) are used.

An important role in the prevention of TIA belongs to the treatment of violations hemostasis. which is being corrected antiplatelet agents and anticoagulants .

Useful for the treatment or prevention of cerebral ischemia and drugs that improve memory: piracetam, which also has antiplatelet properties, actovegin, glycine.

With various mental disorders (neurosis, depression) they fight with tranquilizers, and the protective effect is achieved by the use of antioxidants and vitamins.

Prevention and prognosis

The consequences of an ischemic attack are the recurrence of TIA and ischemic stroke, therefore, prevention should be aimed at preventing a transient ischemic attack so as not to aggravate the situation with a stroke.

In addition to the drugs prescribed by the attending physician, the patient himself must remember that his health is in his hands and take all measures to prevent cerebral ischemia, even if it is transient.

Everyone now knows what role in this regard belongs to a healthy lifestyle, proper nutrition and physical education. Less cholesterol (some people like to fry 10 eggs with pieces of bacon), more physical activity (it’s good to do swimming), giving up bad habits (everyone knows that they shorten life), the use of traditional medicine (various herbal gulls with the addition of honey and lemon ). These funds will definitely help, how many people have experienced it, because TIA has a favorable prognosis, but it is not so favorable for ischemic stroke. And this should be remembered.

Cerebral ischemia is a short-term dysfunction of the central nervous system as a result of impaired blood circulation in certain parts of the brain. It is important to provide first aid correctly so that in the future an ischemic attack does not develop into a stroke.

Transient ischemic attack is a transient or dynamic disorder of the blood supply, which is accompanied by focal disorders of the brain functions. It lasts no more than 24 hours. If minor changes are detected after an ischemic attack of the brain, the patient's condition is defined as an ischemic stroke.

Causes of ischemic attack of the brain

Cerebral ischemia is not a separate disease. It develops against the background of diseases associated with disorders of the heart and other organs. The causes of transient ischemic attack are:

• Atherosclerosis is a vascular disease that manifests itself in deposits on the walls of cerebral vessels of cholesterol plaques that narrow the lumen. This leads to a violation of blood circulation, creates an oxygen deficiency. Manifested in memory impairment, frequent headaches.
• Arterial hypertension is a disease associated with an increase in blood pressure. It is important to always control the pressure.
• IHD is an acute or chronic lesion of the heart muscle as a result of changes in the coronary arteries. The main cause of ischemia of the heart, as well as ischemia of the brain, is occlusion of blood vessels.
• Atrial fibrillation is the most common disease associated with heart rhythm disturbance. It is manifested by unpleasant sensations in the region of the heart, sudden attacks of palpitations, severe weakness.
• Cardiomyopathy is a disease of the myocardium, accompanied by dysfunction of the heart. Appears heaviness in the region of the heart, tingling, shortness of breath and swelling.
• Diabetes mellitus - the basis of the disease is a deficiency in the production of insulin and an excess of glucose production in the blood. The consequence is the slow destruction of the walls of blood vessels.
• Osteochondrosis of the cervical vertebrae reduces blood flow due to inflammation of the intervertebral joints of tissues.
• Obesity creates an additional burden on the work of all organs, including blood vessels.
• Bad habits
• Older age - in men, the age of 60-65 years is critical. In women, the symptoms of an ischemic attack of the brain begin to appear after 70 years.

Symptoms of cerebral ischemia

The onset of the disease is asymptomatic. Vessels do not have nerve endings, so the disease creeps up unnoticed. The main symptoms of an ischemic attack are manifested in a short-term speech disorder, vision problems, fatigue, increasing weakness, memory loss, nervous excitement. There is insomnia or, conversely, drowsiness. There may be severe headaches and dizziness, nausea, vomiting, numbness of the extremities, a feeling of cold, cerebral ischemia, accompanied by loss of consciousness.

Diagnostics

It is necessary to study all the complaints of the patient in order to correctly diagnose. They conduct such studies as a blood test for cholesterol and glucose, a general analysis, cardiography, electroencephalography, ultrasound of the head arteries, duplex scanning of blood vessels, MRI and CT angiography.

Treatment

Treatment of transient ischemic attack should be prescribed by a neurologist. In the fight against cerebral ischemia, therapeutic, surgical, non-drug methods are used.

Therapeutic method

The therapeutic method for the treatment of transient ischemic attack is reperfusion - the restoration of blood circulation in the area of ​​violation. It is carried out by prescribing special drugs to affect the blood clot, if there are no contraindications to this.

Another therapeutic method is neuroprotection - maintaining brain tissue from structural damage. There are primary and secondary neuroprotection. The primary method of treatment is aimed at interrupting the imminent cell death. It is carried out as an emergency from the first minutes and within three days after ischemia. The secondary method is to interrupt delayed cell death, reduce the effects of ischemia. It begins 3 hours after the detection of signs of ischemia. Lasts about 7 days.

The therapeutic method of treatment is accompanied by the following drugs:

• Antiaggregants prevent the formation of blood clots. The most common drug is aspirin.
• Angioprotectors improve the process of blood circulation in the vessels, reduce capillary fragility. These include: Bilobil, Nimodipine.
• Vasodilators help improve cerebral circulation by expanding the passage in the vessels. The main disadvantage of this drug is a decrease in blood pressure, which leads to a deterioration in the supply of blood to the brain. The medicine should be selected individually, taking into account the age of the patient. The most common drugs in this group are Mexidol, Actovegin, Piracetam.
• Nootropic drugs improve brain activity, stimulate the metabolism in nerve cells, protect them from oxygen starvation. Piracetam, Glycine, Vinpocetine, Cerebrolysin are nootropics.

All drugs prescribed by a doctor should be taken in courses: twice a year for two months.

Surgical methods

Surgery is an emergency treatment. They are used in the later stages, when therapeutic treatment does not bring results. One of these methods is carotid endaterectomy, aimed at removing the inner wall of the carotid artery affected by atherosclerosis that destroys it. This operation has a lasting effect. It is usually done under local anesthesia and lasts no more than two hours. An incision is made in the neck area, the carotid artery is isolated, in which a notch is made in the place of the plaque, and the inner wall is scraped. Then stitches are applied.

Transient ischemic attack (TIA) is neurology: according to the international classification of diseases of the tenth revision of the ICD-10, it is a transient (temporary) acute dysfunction of the central nervous system and deformation of the blood flow in certain areas of the spinal cord and brain or the inner membrane of the eye.

This condition goes along with neurological symptoms. An attack occurs within 24 hours, which is a critical period for it, after which all symptoms completely disappear (this creates an additional difficulty for the doctor in determining the diagnosis).

If the symptoms of an ischemic attack continue after a day, brain failure is regarded as an acute stroke.

Therefore, it is important to carry out competent prevention, preventing the aggravation of the manifestations of a transient ischemic attack, than to be content with a long recovery.

What is a transient ischemic attack?

Pathology in most cases haunts people after 45 years of age (more often - after 65 years of age). A transient ischemic attack is distinguished from a stroke by the short duration of development and recovery of the first.

Acute trans-ischemic attack occurs as a result of local disorders. Cerebral signs, such as dizziness, nausea, vomiting, are a manifestation of acute encephalopathic hypertension, when blood pressure rises.

According to the Institute of Neurology of the Russian Academy of Medical Sciences, almost 50% of those who have had a transient heart attack experience an increase in blood pressure. And these pathologies exacerbate each other.

Transient ischemic attacks are regarded by doctors as a warning signal for the occurrence of acute ischemic stroke.

Therefore, as medical practice shows, you need to be most careful in the treatment of a microstroke.

For this, enhanced antiplatelet, vascular, neurometabolic and symptomatic therapy is carried out in order to eliminate severe consequences.

International statistical classification ICD-10

Transactional ischemic attack does not have pronounced signs that go to the doctor. It is not possible to independently determine the development of pathology, which means it is not possible to determine the number of such attacks. . Epidemiologists suggest that in Europeans the disease occurs in 5 out of 10 thousand people.

The frequency of diseases in people older than 45 years is only 0.4%, and also prevails in men aged 65-70 years and in women aged 75-80 years.

Within 5 years before the onset of stroke disease, half of the patients have an ischemic attack.

According to the ICD-10 classification, such TIA and related syndromes are distinguished (G-45.)

Syndrome of the vertebrobasilar arterial system (G45.0) when the skin turns pale and covered with perspiration, the eyeballs themselves begin to move in a horizontal direction, oscillating from side to side and it becomes impossible to independently touch the tip of your nose with your index finger.

Temporary occlusion due to low blood supply to the carotid artery (hemispheric) (G45.1)- for a few seconds, in the direction of the localization of the attack, the eye goes blind, and on the opposite side it goes numb, lose sensitivity or are covered by a cramp of the limb, there is a temporary violation of the speech apparatus, drowsiness, weakness, fainting.

Bilateral multiple symptoms of cerebral (cerebral) arteries (G45.2): short-term disturbances in colloquial speech, reduced sensitivity and motor functions in the limbs, along with temporary loss of vision on the opposite side of the TIA and convulsions.

transient blindness-amaurosisfugax (G45.3).

Transient global amnesia- transient memory disorder with a sudden loss of the ability to remember (G45.4).

Other TIAs and manifestations passing along with attacks (G45.8).

If TIA spasm is present, but its causes are not specified and then the diagnosis is indicated by the code G45.

This is a classification of transient ischemic attack, depending on the area in which the thrombus forms.

Symptoms

Depending on the vascular pool where ischemia manifests itself, transient ischemic attacks occur in the carotid and vertebrobasilar basins (VVB).

Depending on the affected area, determine the place of the brain, which receives less blood supply.

And here neurologists divide the symptoms into two types:

• General- nausea, pain and weakness, dizziness and incoordination, short-term loss of consciousness;
• Local- individual, depending on the affected area.

According to local manifestations, the area affected by the thrombus is determined.

TIA in VVB is the most common occurrence of transient ischemia (occurs in 70 out of 100 cases).

Accompanied by:

TIA in the carotid pool occurs:

• With impaired vision, monocular blindness (in the right or left eye) and disappears as the attack disappears (lasts a few seconds);
• With paroxysmal vestibular and sensory disorders - it is impossible to control the body due to loss of balance;
• Vascular visual disorders - occur in the form of a decrease in sensitivity or complete paralysis of one side of the body, and warns of a microstroke in this area;
• With convulsive syndromes, during which convulsions in the limbs, without loss of consciousness, independently bend and unbend the arms and legs.

TIA in the local area of ​​the blood flow of the retinal artery, ciliary or ophthalmic artery is prone to stereotypic repetition and is accompanied by:

• transient blindness- visual acuity suddenly drops, clouding occurs, colors are distorted, a veil appears on one eye.
• hemianesthesia, a decrease in muscle tone, the occurrence of convulsions, paralysis, which informs about a transient ischemic attack of the carotid arteries.
• Transient global amnesia- occurs after a strong nervous shock or painful sensation. There is a short-term amnesia of new information in the presence of very old information, absent-mindedness, a tendency to repeat, and vestibular ataxia. TGA lasts up to half an hour, after which the memories are restored completely. Similar episodes of TGA may recur after several years. A patient in a coma may have a symptom of a sail, which is so called because of the resemblance of swelling during breathing of the cheek on the side opposite to the paralyzed one.

The difficulty in determining the diagnosis lies in the fact that the symptoms of the attack are short-lived and the neuropathologist is forced to diagnose TIA only from the words of the patient, which will depend on the pathological zone of cerebral blood flow.

Despite the reversibility of the symptoms, it must be remembered that at the time of the onset of a spasm, the arteries carrying oxygen and vital substances stop the processes.

Energy is not produced, and the cells suffer from oxygen starvation (temporary hypoxia is observed).

The damage to the body from the attack will depend on the area of ​​the affected area, but even small local attacks will bring considerable harm to health.

Signs of aortic brain attacks

The occurrence of pathological processes in the blood circulation in the aortic zone before the bifurcation of the carotid and vertebral vessels is marked by symptoms:

• Photopsia, diplopia;
• Noise in the head;
• vestibular ataxia;
• Drowsiness and decreased physical activity;
• Dysarthria.

Violation can appear with congenital heart disease.

And if there is an increase in blood pressure, then there are:

• Headache;
• vestibular ataxia;
• Weakness in limbs;
• Nausea and vomiting.

Attack symptoms become more pronounced if the patient begins to change the position of the head and the risk of TIA increases (table 1).

The main causes of transient ischemic attacks

Can be defined as:

These factors are the reason for the insufficient supply of oxygen and vital substances to the vessels of the brain, which increases the load on them.

And instead of blood flow, a spasm occurs in one of the areas, which violates the proportions between the necessary and received nerve cells.

Diagnostics

Diagnosis of a transient ischemic attack is difficult due to the transience of the attack, the doctor learns about the attack only from the patient's words, which may be completely inaccurate.

For diagnosis, consider the following:

• Similar signs occur with irreversible cerebral disorders, because of this it is worth using all kinds of methods for diagnosing TIA;
• After an attack, the patient is at high risk of having a stroke;
• The clinic, which has a full-fledged neurological technical equipment, is the best hospital for hospitalization and appropriate examination of a patient who has had an attack.

During emergency hospitalization, the patient undergoes: spiral computed tomography or MRI (magnetic resonance imaging).

Of the laboratory research methods, the patient after a transient ischemic attack is given the following:

• Clinical analysis of peripheral blood (circulating through the vessels outside the hematopoietic organs);
• Biochemical studies (antithrombin III, protein C and S, fibrinogen, anticardiolipin antibodies and others), which provide a complete analysis of the functioning of the liver and kidneys and the presence of tissue death;
• Expanded hemostasiogram to determine the index of blood clotting;
• General analysis of blood and urine (determination of the work of the liver and kidneys, urinary tract, detection of pathologies);

For the examination of the patient is assigned:

• Electroencephalogram (EEG)- allows you to diagnose neurological diseases and determine the presence of brain tissue lesions;
• Electrocardiography (ECG) in 12 leads- determines the development of arrhythmias, disorders of the heart;
• Daily (Holter) ECG monitoring- if there are relevant indications;
• Echocardiography (EchoCG)– method of examination and evaluation of the heart and its contractile activity;
• Lipidogram- a comprehensive study that determines the level of lipids (fats) of various blood fractions;
• Angiography of the arteries of the brain used to study the vessels of the circulatory and lymphatic systems, the development of a network of auxiliary vessels, the presence of thrombosis (carotid, vertebral and selective).

In addition to a neuropathologist, a patient who has had an ischemic attack should be examined by doctors such as a cardiologist, an ophthalmologist, and a general practitioner.

Also, differential diagnosis is carried out to exclude the occurrence of other diseases, such as:

• Epilepsy;
• fainting;
• eye migraine;
• Pathology of the inner ear;
• myasthenia;
• panic attacks;
• Horton's disease.

By excluding diseases that do not fit in terms of symptoms and factors, the only correct diagnosis will be determined and the correct treatment will be prescribed.

Treatment

The main task of treatment after a transient ischemic attack is to prevent the ischemic process, restore normal blood circulation and metabolism of the ischemic cerebral area.

When a transient cerebrovascular accident occurs, doctors recommend hospitalization of the patient in order to prevent its complications in the future at an early stage of TIA.

Hospitalization is required if you have frequent symptoms listed above that prevent you from functioning normally.

If the symptoms are extremely rare, then you can treat at home., but only under the supervision of a doctor and fulfilling all his instructions.

A set of measures taken to restore blood flow, eliminate oxygen starvation in the area of ​​impaired vascularization and drug protection of the brain is presented in Table 2.

It is necessary to keep under control the intake of drugs affecting the level of blood pressure. These may include diuretics.

Diabetics with transient ischemic attack need to take drugs that lower glucose levels through sugar reduction.

Patients who have been found to have thrombus formation, if the initial phenomena of thrombosis are detected in stationary conditions, fibrinolytic therapy is performed to reduce the size of the intracoronary thrombus.

You can use traditional medicine to improve the overall immune system and protect against atherosclerosis. These can be teas, decoctions and tinctures with clover, hawthorn, lemon, garlic and fish oil supplements. But such methods cannot replace medical treatment.

Prognosis for TIA

Usually, after such an attack, there is a high probability of developing the next one. Furthermore, such attacks can become systematic. An important role in predicting the consequences of TIA is played by a timely response to symptoms.

If the patient himself and his relatives quickly noticed the characteristic clinical manifestations and realized that an ischemic attack had begun, then there is an opportunity to take immediate measures to prevent its consequences.

In this case, it is necessary to quickly hospitalize the patient and conduct appropriate therapy. Such actions not only reduce the negative impact of the attack on the body, but also provide an opportunity for their reverse development.

Is it possible to predict the likelihood of a stroke in a TIA?

One common prognosis after a TIA is a stroke. According to statistics, it develops in 10% of patients affected by an attack within the first 24 hours. In 20% of patients, a stroke occurs within three months after the attack, in 30% this period can be up to five years.

The occurrence of strokes is closely related to ischemic attacks. Therefore, after the occurrence of such an attack, a person automatically falls into a risk group.

He is receiving more attention from doctors and it is recommended to devote more time to stroke prevention and maintaining a healthy lifestyle. Preventive therapeutic procedures may also be carried out.

It is important to monitor the state of health and observe the dynamics. In this case, we can more accurately talk about the possibility of a stroke after an ischemic attack.

Prevention

Primary and secondary prevention of transient ischemic attack in this case is:

Prevention is complemented by traditional medicine.

Which doctor should I contact?

In the event of a TIA, the patient should be hospitalized. The profile department will be neurological.

After the main crisis period is over, the cardiologist and neurologist will become the main attending physicians of the patient who had an attack.

Since the solution of the problem requires the treatment of blood vessels and accompanying possible neurological consequences. Also, it is the cardiologist who gives recommendations on how to prevent the possible recurrence of such conditions.

conclusions

Timely treatment of TIA prevents stroke. Anti-ischemic therapy restores blood supply to the brain, improves metabolism and oxygen saturation of cells.

In the event of a transient ischemic attack, the doctors' requirements for hospitalization for a month are fully justified.

Since the attending doctor, due to the transience of symptoms, cannot see them himself, he directs them to diagnostics in order to clarify the diagnosis and prescribe adequate treatment.

Video: Transient ischemic attack - a harbinger of a stroke.

A transient ischemic attack, which is also called a microstroke, is a violation of cerebral blood flow, which is acute in nature and disappears a day after the onset of development.

Symptoms of pathology depend on the localization of abnormal processes. This condition occurs suddenly and can lead to dangerous consequences.

Many people are interested in the treatment of transient ischemic attack at home.

The reasons

The development of pathology leads to a violation of blood circulation in a certain part of the brain. The reasons for this condition are as follows:

In addition, diseases such as diabetes mellitus, arterial hypertension, and cholesterolemia can become provoking factors. Often the cause is bad habits, lack of movement, the presence of excess weight.

Symptoms

This pathology can have different symptoms, which depend on the area of ​​​​damage localization.

With the defeat of the carotid arteries or the carotid pool, the following symptoms appear:

If transient ischemia manifests itself in the vertebrobasilar basin, a different clinical picture is observed.

This pathology is accompanied by such symptoms:

• headaches, which are mainly localized in the back of the head;
• dizziness;
• memory impairment;
• problems with coordination of movements;
• dysphagia;
• a sharp deterioration in hearing, vision, speech;
• paresis and loss of sensitivity - most often some part of the face becomes numb.

Emergency care should be provided when the following signs appear:

First aid

It is impossible to cope with a microstroke at home. Therefore, when its symptoms appear, you should immediately call an ambulance. In this state, time plays a big role. Due to timely actions, dangerous consequences can be prevented.

First aid to the patient should be provided immediately. For this person, you should put him to bed and raise his head a little. Of no small importance is the provision of complete peace - sound and moral.

Any stress can lead to a deterioration in well-being. It is imperative to create the right sanitary conditions so that a person does not have to get up to go to the toilet.

Treatment

Therapy of cerebral circulation should be carried out in a special neurological department. It should be aimed at eliminating seizures and preventing stroke.

Treatment consists in restoring blood circulation and eliminating the consequences of pathology.

To cope with the disease, antihypertensive drugs are selected. We also need drugs to improve the functioning of the blood coagulation system.

To do this, you need to use the following tools:

A week after the attack, procedures are prescribed to restore the patient's condition. Rehabilitation after a transient ischemic attack includes special massages and therapeutic exercises. Also, the patient may need to consult a psychologist and a speech therapist.

Some of the most popular home remedies for transient ischemic attack include the following:

• biologically active additives;
• fish fat;
• phytotherapy;
• the use of iodized foods - in particular, seaweed;
• medicinal sweet clover;
• alcohol tincture of nutmeg.

It is permissible to use alternative methods of treatment only after consulting a doctor and conducting adequate drug therapy.

Forecast

If, with the appearance of the first symptoms of a transient ischemic attack, it was possible to provide the patient with qualified assistance, a reverse development of the abnormal process is possible. In such a situation, the patient can return to their usual way of life.

In some cases, pathology can lead to ischemic stroke. In such a situation, the prognosis worsens significantly. Sometimes even death occurs.

The risk group includes people who suffer from diabetes, hypertension or atherosclerosis. The same applies to patients with bad habits.

To prevent the development of a stroke and other consequences of a transient ischemic attack, you need to engage in prevention:

• take medicines for hypertension;
• take drugs that help to cope with the formation of cholesterol plaques;
• keep sugar levels under control for those who suffer from diabetes;
• take aspirin to prevent blood stasis;
• perform surgery for blockage of the carotid arteries.

Transient ischemic attack is a serious pathology that can cause dangerous consequences.

In order to prevent the development of complications, you should consult a doctor in time, who will select effective medicines. As an addition to standard therapy, alternative recipes can be used.

The term "ischemic attack" is the modern name for transient disorders of cerebral circulation in accordance with the International Statistical Classification ICD-10. Paroxysmal manifestations or “attacks” that a person experiences are temporary (transient) in nature, more often they pass on their own.

Without fail, against the background of another ischemic attack, there is a reduction in the blood supply to a certain area of ​​the brain. The critical period of neurological symptoms is 24 hours. If cerebral insufficiency lasts longer, then the condition is regarded as a stroke.

Therefore, varieties of transient ischemic attacks (TIA) are considered by doctors as a very likely harbinger of acute ischemic stroke. The name of a microstroke has stuck among the people. It is practically important to start intensive therapy during this period. Rational treatment avoids serious consequences.

International classification

Due to the inconsistent nature of complaints, not all patients turn to the clinic. Therefore, it is impossible to provide reliable data on the frequency and prevalence of this brain pathology. The fact of the presence of previous transient cerebral ischemia within five years before the stroke was established in 30–50% of patients.

The ICD-10 identifies a subgroup of transient cerebral ischemic attacks and related syndromes with the G45 code.

Their variants reflect the most frequent localization of the occurrence of a short-term mechanical obstruction in the arteries that feed the brain:

• G45.0 - level of the vertebrobasilar arterial system;
• G45.1 - impaired blood supply to the cerebral hemisphere due to temporary overlap of the carotid artery;
• G45.2 - multiple nature of vascular lesions on both sides;
• G45.3 - the symptom of transient blindness predominates in the clinic;
• G45.4 - leading manifestation - temporary amnesia (memory loss);
• G45.8 - transient ischemic attack associated with other causes;
• G45.9 - the code is put in the diagnosis if there are signs of TIA, but the reasons are not specified.

What happens in the vessels and cells of the brain?

During an ischemic attack, the arteries that carry oxygen and nutrients to different parts of the brain undergo a short-term spasm. This is caused by a disturbed vascular response, a failure of the “controlling” function of the cortical nuclei.

Perhaps they play a negative role:

• vascular inferiority due to genetic predisposition;
• impaired coagulating properties of blood (hyperprothrombinemia increases thrombus formation);
• the process of autoallergy - the formation of antibody complexes on the inner walls of blood vessels;
• inflammatory reactions in vasculitis.

Even a short-term disruption in the supply of brain cells (neurons) disrupts the process of energy production inside, causes oxygen deficiency (hypoxia), and stops all types of metabolism.

Clinical symptoms depend on the extent of the lesion and its location. They differ from the manifestations of a stroke by returning to a normal state during the day.

Causes and factors contributing to temporary ischemia

The causes of TIA of the brain coincide with the main provoking factors of ischemic stroke:

• men over the age of 50 are most susceptible to attacks;
• atherosclerotic changes in blood vessels;
• hypertension;
• systemic vascular diseases of an inflammatory and autoimmune nature (lupus erythematosus, vasculitis);
• overweight (obesity) and endocrine pathology;
• diabetes;
• change in the bone processes of the spine in the cervical region;
• heart disease, arrhythmias;
• nicotine poisoning when smoking;
• the effect of alcohol.

All of these factors disrupt the correct reaction of the brain vessels in response to an increase in the need for nutrients, mental work, and physical activity. Instead of an increased blood supply, a spasm occurs, which leads to a more or less pronounced disproportion between the “request” of neurons and provision.

In the presence of severe cardiac and endocrine diseases, transient ischemia is possible in childhood and adolescence.

Clinical manifestations

The symptoms of TIA are determined by the location of the lesion. In diagnostics, they indicate an unfavorable area of ​​​​the blood supply to the brain. In neurology there are:

• cerebral symptoms - dizziness, headache attack, nausea, weakness, short-term loss of consciousness;
• local manifestations are more specific, typical for certain areas of the lesion.

For any dizziness, staggering when walking, you need to find out the cause

It is by focal manifestations that one form of TIA can be distinguished from another.

Vertebrobasilar attacks- the most frequent manifestation of temporary ischemia (up to 70% of all cases). They have very diverse clinical symptoms. Occur when turning the head or spontaneously.

Syndrome of "cervical" migraine- associated with damage to the vertebral arteries in deforming spondylosis and osteochondrosis of the cervical vertebrae. Appears:

• acute pain in the back of the head and neck with irradiation over the surface of the head in the form of a "helmet" to the eyebrows;
• dizziness and fainting;
• nausea;
• tinnitus.

Vestibular disorders- sensation of "rotation of objects", loss of balance, nystagmus of the eyeballs.

Atonic and adynamic changes- transient weakness, loss of muscle tone.

convulsive syndrome- characterized by convulsions in the arms and legs without loss of consciousness, there is an extension and stretching of the limbs.

Vascular visual disorders- the patient describes a sudden visual impairment, spots and dots before the eyes, optical figures, a change in color perception.

Transient speech disorders.

Paroxysmal contractions of the diaphragm - cause coughing fits, hypertension, palpitations, tear and salivation, constriction of the pupils.

When studying the patency of the carotid arteries, it is possible to identify pathology

Carotid transient ischemic attacks are associated with impaired blood circulation at the level of the carotid arteries. Typical symptoms:

• headache;
• short-term disturbance of consciousness or orientation;
• temporary acute weakness and impaired sensitivity in the arms and legs (muscle hypotension and paresthesia);
• slight speech disturbances are possible.

Signs of aortic-cerebral attacks

In case of violation of blood circulation in the aortic zone to the outgoing carotid and vertebral arteries, the attacks are in the nature of more severe carotid-vertebral ones. Patients appear:

• short-term darkening in the eyes;
• dizziness and noise in the head;
• orientation in space is disturbed;
• sudden weakness in the limbs;
• speech disorders.

Pathology can occur with coarctation of the aorta. At the same time, against the background of high blood pressure, there are:

• sharp headaches;
• feeling of heaviness in the back of the head;
• a sensation of swaying or rotating objects around;
• decreased muscle tone;
• staggering when walking;
• nausea and vomiting.

Manifestations intensify during a change in the position of the head.

Tinnitus is excruciating

Attack Severity Criteria

The basis of the criteria for the severity of ischemic attacks is the necessary time for the full restoration of body functions. It is customary to distinguish:

• mild degree - if the duration of the attack is up to ten minutes;
• moderate - duration from 10 minutes to several hours, in the absence of any residual effects after an attack;
• severe - the attack lasts from several hours to a day, mild organic symptoms are possible and subsequently.

Diagnostics

Diagnosis during an attack is complicated by its transience. But the causes of an ischemic attack remain, so it is necessary to determine them with the greatest accuracy. Consider the following:

• similar symptoms occur with organic pathology of the brain (tumors, migraine, meningitis), so all available diagnostic methods should be used;
• the patient has an increased risk of stroke;
• The most complete technical base is possessed by specialized hospitals of a neurological profile, it is better to undergo an examination in a hospital setting.

The survey plan should include:

• analysis of peripheral blood;
• biochemical tests indicating the functioning of the liver and kidneys, the presence of tissue necrosis;
• lipidogram with the determination of the ratio of high and low density lipoproteins, triglycerides;
• expanded coagulogram for studying coagulation processes;
• urine analysis to confirm the function of the liver and kidneys, to identify elements of inflammation, impaired permeability of the vascular wall;
• dopplerography of the arteries of the neck and brain will determine the change in blood flow velocity, the initial stage of atherosclerosis, narrowed zones, volumetric formations from brain tissue and vascular origin (tumors, aneurysms);
• angiography of the vascular system of the cerebral arteries is used to identify the degree of circulatory disorders, thrombosis, the development of the network of auxiliary vessels;
• an electroencephalogram makes it possible to distinguish signs of vascular pathology from other organic brain lesions;
• an electrocardiogram helps to detect arrhythmias, myocardial diseases and impaired contractility of the heart.

Magnetic resonance (MRI) and computed tomography are performed to exclude the association of symptoms with tumors, the presence of intrathecal hematoma

As a "mirror" of the cerebral vessels, the picture of an ophthalmoscopic examination of the fundus, which is carried out by an eye doctor, is used.

For the correct diagnosis and treatment, the participation of several specialists is necessary, including a therapist, neurologist, oculist, cardiologist.

Treatment

The main objective of therapeutic measures is the prevention of stroke. Therefore, it is required to start therapy at an early stage, without waiting for severe ischemic attacks and their recurrence.

Hospitalization is necessary for frequent attacks that disrupt the ability to work. If the examination is carried out and ischemic attacks occur rarely, treatment can be carried out at home under the supervision of the attending physician of the clinic.

Directions of therapy:

• for blood thinning, such popular drugs as Aspirin, ThromboAss, Cardiomagnyl are recommended, if they are poorly tolerated due to concomitant diseases of the stomach, Ticlopedin is prescribed;
• in stationary conditions, Reopoliglyukin is injected intravenously;
• statin drugs are widely used to lower blood cholesterol levels and delay the development of atherosclerosis, these include Atorvastatin, Simvastatin, Pravastatin;
• to relieve vascular spasm, coronary drugs are used: Papaverine, nicotinic acid, Nicoverine;
• the drugs that restore the microcirculation of the cerebral vessels include Cavinton, Vinpocetine;
• nootropics (Piracetam, Nootropil, Cerebrolysin) are involved in the preservation of neurons and their provision with additional energy for recovery.

The drug, coming from Germany, requires caution in the use of patients with diseases of the kidneys, liver, diabetes

Recently, there has been a discussion about the advisability of using statins, since the craze and hopes have turned into complications in the form of a disturbed psyche. Women are especially prone to them. Therefore, the appointment is considered justified if a two-month strict diet has not led to the normalization of blood cholesterol levels. And with a normal content of lipoproteins, there is no need to use them.

It is necessary to control the level of blood pressure and take drugs for hypertension, according to indications - diuretics. Patients with diabetes cannot get rid of transient attacks without maintaining normal blood glucose levels with the help of antidiabetic drugs.

When the initial effects of thrombosis are detected in a stationary setting, fibrinolytic therapy is performed in an attempt to dissolve and remove the thrombosis.

Complementary therapies:

• if there is a connection between ischemic attacks and cervical osteochondrosis, electrophoresis with drugs that relieve muscle spasm, gentle massage of the collar zone, Darsonval currents on the head are prescribed;
• oxygen, coniferous, radon baths have a good relaxing effect, they are best done in courses in sanatorium conditions;
• physical therapy helps to restore impaired blood circulation, develop a network of auxiliary vessels.

From folk remedies, any reasonable recipes for the prevention of atherosclerosis, strengthening the immune system are suitable. These include lemon-garlic tincture, hawthorn, rosehip decoction, clover, fish oil supplements. Do not try to replace drugs with them. It is impossible to get rid of atherosclerotic plaques with folk remedies.

Is it possible to predict the likelihood of a stroke in a TIA?

Clinical studies have confirmed a reduction in the incidence of ischemic stroke in the group of patients taking treatment by 30-45%. This is with reliable data on the detection of stroke:

• in the coming years in ¼ of patients with ischemic attacks;
• during the first week - in 43% of cases.

Therefore, the requirements of doctors to go to the hospital, even if the symptoms have disappeared, unequivocally and provides the patient with the prevention of serious disorders.

The left column of the table contains links to the authors of the studies, the reliability is not in doubt and is confirmed by the number of participants

It is not necessary to rely only on medicines without observing personal protection rules. The consequences depend more on a person's lifestyle than on drugs. Recommended:

• avoid smoking and alcohol;
• adhere to an anti-atherosclerotic diet for the rest of your life (sharply limit animal fats, high-calorie foods, switch to vegetable oils, fish, dairy products with reduced fat content, be sure to eat vegetables and fruits at any time of the year);
• physical activity is limited only in heavy sports, walking, swimming, fitness, cycling are shown;
• control of blood pressure will help prevent TIA in a timely manner, get rid of brain problems.

Transient ischemic attacks should be treated as a warning bell for an increased risk of stroke. By listening to the "signals" of your body, you can avoid severe pathology, prolong an active life and not be a burden to relatives and friends.