Transient ischemic attack in vbb. Transient ischemic attack (TIA) of the brain: signs and treatment

One of the types of circulatory disorders in the brain tissue, which occurs in an acute form for 10-15 minutes to a day and is manifested by both cerebral and focal symptoms of brain damage, is a transient ischemic attack (TIA). If the symptoms of an attack do not disappear within the specified time, this condition is already diagnosed as an ischemic stroke. Thus, TIA can be regarded as a warning of the body about the possible development of a stroke.

Types of transient ischemic attack

There are three types of the disease, which directly depend on the course of the disease.

Light form. Neurological symptoms last up to 10 minutes, disappear without medical therapy and do not cause any negative consequences.
Medium form. Symptoms appear from 10 minutes to several hours. Leaves no consequences, but, as a rule, requires the use of therapy.
Severe form. Symptoms last up to 24 hours, require therapy, and cause minor neurological consequences that do not affect a person's daily life.

The reasons

Consider the causes that provoke the development of TIA.

The main factor due to which transient ischemic attacks are observed is atherosclerosis of the arteries of the brain, including the main vessels. Due to these problems, the formation of atherosclerotic plaques occurs, as well as changes in the blood vessels of a structural nature.
The second reason is arterial hypertension (hypertension). If the blood pressure indicators are constantly higher than normal, then irreversible changes occur in the walls of the vessels (thickening caused by internal fibrin deposits).

Approximately 20% of all cases when a transient ischemic attack occurs are associated with the presence of the following pathologies:

rheumatic heart disease;
cardiopathy and atrial fibrillation;
endocarditis;
heart attack;
aneurysms;
prolapse and the presence of congenital heart disease;
aortic stenosis;
dissection of the arteries;
primary vascular disorders of inflammatory origin;
gynecological changes;
fibromuscular dysplasia;
Moya-Moya syndrome.

Symptoms

Transient ischemic attack causes focal symptoms, which are explained by the area of its occurrence. For example, if the disease develops in the part of the brain that controls vision, then the symptoms will be associated with its violation. In case of damage to the area that is responsible for the vestibular apparatus, dizziness, unsteadiness of gait occur, the person is poorly oriented.

Common symptoms of transient ischemic attack:

dizziness;
nausea, which may be accompanied by vomiting;
speech activity disorders (speech is illegible and incomprehensible to others),
numbness of the face or its individual parts,
short-term impairment of vision, sensitivity and functions responsible for motor activity;
disorientation in time and space (cannot answer the simplest questions, even give his name).

There are two types of TIA.

Ischemia that occurred in the carotid pool, which consists of two internal carotid arteries. Its functions are to supply blood to the cerebral hemispheres, which are responsible for movement, memory, writing, counting, sensitivity.
Ischemia that has arisen in the vertebrobasilar arterial basin, which form two vertebral arteries. They supply blood to the brainstem, which is responsible for breathing and circulation.

If a transient ischemic attack of the first type develops, then the patient develops unilateral paralysis (the sensitivity of the limbs is dulled, and their mobility is limited), speech impairment. A person cannot perform elementary actions related to motor skills, for example, take an object. Quite often there is a deterioration in vision, the patient wants to sleep, apathy sets in, and consciousness is confused.

In case of damage to the vertebrobasilar zone during a transient ischemic attack, other symptoms occur: dizziness or severe headache, nausea and vomiting often occur, the mouth and half of the face go numb, speech disorders, swallowing function occur, the tongue deviates to the side when protruding from the mouth, vision worsens, double vision, lower and upper limbs tremble, a person is not able to stand, move, stay in a state of lying on his side, cannot answer either his name or what day of the week, short-term memory loss occurs.

Treatment

First aid

Treatment of a transient ischemic attack involves, first of all, a return to normal blood circulation. These activities will be carried out by medical professionals. If you are close to a victim who has an attack, you must quickly and correctly provide first aid.

Call the ambulance team. It should be remembered that drug therapy will be effective in the first 3 hours after the development of an attack. That is why it is necessary to deliver the patient to a medical facility as soon as possible.
Open a window so that there is access to fresh air, unbutton the patient's collar, loosen the belt of his trousers, and eliminate all factors that interfere with free breathing.
While the ambulance is expected to arrive, the person should be reassured, laid down, remembering that the head should be in an elevated position. This is necessary so that the patient spends less energy, and psychological stress does not cause an increase in vasospasm.
After the ambulance doctor provides first aid, he asks the person to make a sentence, answer questions, smile, and raise his upper limbs. These actions will help determine how well the brain is working. If the patient hardly performs these actions or cannot perform them at all, then the question of hospitalization arises.

Treatment in a hospital

Without an examination, it is quite difficult to establish an accurate diagnosis, because quite often, by the time the ambulance team arrives, the symptoms of a transient ischemic attack disappear without drug therapy. However, the relatives of the patient and the victim himself should know: there is no need to refuse hospitalization, while remembering that the optimal time to take a person to the hospital is three hours from the moment the first signs of the disease develop.

Only in a specialized hospital is it possible to both identify the localization and the degree of damage to the parts of the brain caused by TIA. In addition, of paramount importance is the identification of the reasons for which the attack occurred. If it developed due to arterial embolism, then the person may soon suffer from a stroke. The most effective time for hospitalization in the presence of signs of a TIA is 3 hours from the time the first symptoms appeared.

The doctor will not prescribe treatment until a comprehensive examination of the patient is carried out:

blood test (biochemical and clinical);
electroencephalography;
CT scan;
Magnetic resonance imaging;
dopplerography using ultrasound);
angiography and ECG of the heart.

What does the doctor take into account when it comes to an attack of an ischemic attack in a patient?

Attention! All the necessary examinations, the appointment of medications, the selection of the dosage is carried out exclusively by a specialist! Self-treatment of a transient ischemic attack is an unacceptable luxury, unless, of course, you want to get negative consequences in the form of an aggravation of the course of the disease, the development of a stroke and other unpleasant ailments).

Prevention

The disease is much easier and easier to prevent than to cure. That is why every person who has had an ischemic attack should have certain knowledge that will help him prevent such a condition. Preventive measures for TIA include the following:

systematic monitoring of blood pressure indicators, if necessary, taking medications prescribed by the doctor to normalize the condition;
periodic monitoring of cholesterol, and diet;
periodic monitoring of sugar levels;
cessation of smoking, taking alcoholic beverages in high doses;
control of body weight, limiting the consumption of flour products, sweets, high-calorie foods;
evening walks (daily), performing a complex of gymnastics, feasible physical work (at a moderate pace).

A transient ischemic attack (TIA) is a transient episode of central nervous system dysfunction caused by an interruption in the blood supply (ischemia) to certain limited areas of the brain, spinal cord, or retina without evidence of acute infarction. According to epidemiologists, this disease occurs in 50 out of 100,000 inhabitants of Europe. Most often, they suffer from elderly and senile people, and among the sick people aged 65-69 years, men predominate, and women aged 75-79 years. The incidence of TIA in younger - aged 45-64 years - individuals is 0.4% of the total population.

In many ways, competent prevention of this condition plays an important role, since it is easier to prevent the development of a transient ischemic attack by identifying the causes and symptoms of the disease in time than to devote a long time and effort to its treatment.

TIA and risk of ischemic stroke

Often shortly after a TIA, an ischemic stroke develops.

TIA increases the risk of ischemic stroke. So, in the first 48 hours after the onset of TIA symptoms, a stroke develops in 10% of patients, over the next 3 months - in another 10%, within 12 months - in 20% of patients, and in the next 5 years - another 10-12 % of them end up in the neurological department with a diagnosis of ischemic stroke. Based on these data, it can be concluded that transient ischemic attack is an emergency condition that requires emergency medical care. The sooner this assistance is provided, the greater the patient's chances for recovery and a satisfactory quality of life.

Causes and mechanisms of development of transient ischemic attack

TIA is not an independent disease. Its occurrence is facilitated by pathological changes in blood vessels and the blood coagulation system, dysfunction of the heart and other organs and systems. As a rule, transient ischemic attack develops against the background of the following diseases:

coronary heart disease (in particular,);
dilated cardiomyopathy;
artificial heart valves;
systemic vascular diseases (damage to the arteries in collagenoses, granulomatous arteritis and other vasculitis);
antiphospholipid syndrome;
coarctation of the aorta;
pathological tortuosity of cerebral vessels;
hypoplasia or aplasia (underdevelopment) of cerebral vessels;

Also, risk factors include a sedentary lifestyle and bad habits: smoking, alcohol abuse.

The risk of developing a TIA is higher, the more risk factors are present simultaneously in a particular person.

The mechanism of TIA development is a reversible decrease in blood supply to a particular area of the central nervous system or retina. That is, a thrombus or embolus is formed in a certain part of the vessel, preventing blood flow to the more distal parts of the brain: they experience an acute lack of oxygen, which is manifested by a violation of their function. It should be noted that with TIA, the blood supply to the affected area is disrupted, although to a large extent, but not completely - that is, some amount of blood does reach the “destination”. If the blood flow stops completely, a cerebral infarction develops, or ischemic.

In the pathogenesis of the development of a transient ischemic attack, not only the thrombus that clogs the vessel plays a role. The risk of its blockage increases with the existing vascular spasm and increased blood viscosity. In addition, the risk of developing a TIA is higher under conditions of reduced cardiac output: when the heart does not work at full capacity, and the blood it pushes out cannot reach the most distant parts of the brain.
TIA differs from myocardial infarction by the reversibility of the processes: after a certain period of time - 1-3-5 hours a day - the blood flow in the ischemic area is restored, and the symptoms of the disease regress.

TIA classification

Transient ischemic attacks are classified depending on the site in which the thrombus is localized. According to the international classification of diseases X revision TIA can be one of the following options:

syndrome of the vertebrobasilar system;
hemispheric syndrome, or carotid artery syndrome;
bilateral multiple symptoms of cerebral (cerebral) arteries;
transient blindness;
transient global amnesia;
unspecified TIA.

Clinical manifestations of transient ischemic attacks

One of the leading symptoms of TIA is severe dizziness.

The disease is characterized by a sudden onset and rapid regression of neurological symptoms.

Symptoms of TIA vary widely and depend on the area of the thrombus (see classification above).

With vertebrobasilar artery syndrome, patients complain of:

severe dizziness;
intense tinnitus;
, vomiting, hiccups;
increased sweating;
impaired coordination of movements;
severe headaches mainly in the occipital region;
violations of the organ of vision - flashes of light (photopsia), loss of parts of the field of view, veil before the eyes, double vision;
fluctuations in blood pressure;
transient amnesia (memory impairment);
rarely - a violation of speech and swallowing.

Patients are pale, skin of their increased humidity. On examination, attention is drawn to spontaneous horizontal nystagmus (involuntary oscillatory movements of the eyeballs in the horizontal direction) and impaired coordination of movements: unsteadiness in the Romberg position, negative finger-nose test (the patient with closed eyes cannot touch the tip of the nose with the tip of the index finger - misses ).

With hemispheric syndrome, or carotid artery syndrome, the patient's complaints are as follows:

a sudden sharp decrease or complete absence of vision in one eye (on the side of the localization of the lesion) lasting several minutes;
severe weakness, numbness, decreased sensitivity of the limbs on the side opposite to the affected organ of vision;
weakening of voluntary movements of the muscles of the lower part of the face, weakness and numbness of the hand on the opposite side;
short-term unexpressed speech disorder;
short-term, opposite side of the lesion.

With the localization of the pathological process in the region of the cerebral arteries, the disease manifests itself with the following symptoms:

transient speech disorders;
sensory and motor disturbances on the side opposite to the side of the lesion;
seizures;
loss of vision on the side of the affected vessel, combined with impaired movement in the limbs on the opposite side.

With pathology of the cervical spine and the resulting compression (compression) of the vertebral arteries may cause attacks of sudden severe muscle weakness. The patient falls for no reason, he is immobilized, but his consciousness is not disturbed, convulsions and involuntary urination are also not noted. After a few minutes, the patient's condition returns to normal, muscle tone is restored.

Diagnosis of transient ischemic attacks

With symptoms similar to those of a TIA, the patient should be hospitalized in the neurological department as soon as possible. There, he will undergo an emergency spiral computed tomography or magnetic resonance imaging to determine the nature of the changes in the brain that caused neurological symptoms, and to differentially diagnose TIA with other conditions.

ultrasound examination of the vessels of the neck and head;
magnetic resonance angiography;
CT angiography;
rheoencephalography.

These methods allow you to determine the exact localization of the violation of the patency of the vessel.
Electroencephalography (EEG), electrocardiography (ECG) in 12 leads and echocardiography (EchoCG) should also be performed, if indicated, daily (Holter) ECG monitoring.
Of the laboratory research methods for a patient with TIA, the following should be carried out:

clinical blood test;
study of the coagulation system, or coagulogram;
specialized biochemical studies (antithrombin III, protein C and S, fibrinogen, D-dimer, lupus anticoagulant, factors V, VII, von Willebrand, anticardiolipin antibodies and others) are prescribed according to indications.

In addition, the patient is shown consultations of related specialists: a therapist, a cardiologist, an ophthalmologist (oculist).

Differential diagnosis of transient ischemic attacks

The main diseases and conditions from which TIA should be differentiated are:

migraine aura;
epileptic seizures;
diseases of the inner ear (acute labyrinthitis, benign recurrent);
metabolic disorders (hypo-and, hyponatremia, hypercalcemia);
fainting;
panic attacks;
multiple sclerosis;
myasthenic crises;
Horton's giant cell temporal arteritis.

Principles of treatment of transient ischemic attacks

Treatment for TIA should be started as soon as possible after the onset of the first symptoms. The patient is shown emergency hospitalization in the neurological vascular department and intensive care. He may be assigned:

infusion therapy - reopoliglyukin, pentoxifylline intravenous drip;
antiplatelet agents - acetylsalicylic acid at a dose of 325 mg per day - the first 2 days, then 100 mg per day alone or in combination with dipyridamole or clopidogrel;
anticoagulants - clexane, fraxiparine under the control of the INR blood indicator;
neuroprotectors - ceraxon (citicoline), actovegin, magnesium sulfate - intravenously;
nootropics - piracetam, cerebrolysin - intravenously;
antioxidants - phytoflavin, mexidol - intravenously;
lipid-lowering drugs - statins - atorvastatin (atoris), simvastatin (vabadin, vasilip);
antihypertensive drugs - lisinopril (Lopril) and its combinations with hydrochlorothiazide (Lopril-N), amlodipine (Azomex);
insulin therapy in case of hyperglycemia.

Blood pressure cannot be sharply reduced - it is necessary to maintain it at a slightly elevated level - within 160-180 / 90-100 mm Hg.

If there are indications, after a full examination and consultation of a vascular surgeon, the patient undergoes surgical interventions on the vessels: carotid endarterectomy, carotid angioplasty with or without stenting.

Prevention of transient ischemic attacks

Measures of primary and secondary prevention in this case are similar to each other. It:

adequate therapy of arterial hypertension: maintaining the level of pressure within 120/80 mm Hg by taking antihypertensive drugs in combination with lifestyle modification;
maintaining blood cholesterol levels within normal limits - by rationalizing nutrition, an active lifestyle and taking lipid-lowering drugs (statins);
giving up bad habits (sharp restriction, or better, complete cessation of smoking, moderate consumption of alcoholic beverages: dry red wine at a dose of 12-24 grams of pure alcohol per day);
taking drugs that prevent thrombosis - aspirin at a dose of 75-100 mg per day;
treatment of pathological conditions - risk factors for TIA.

Prognosis for TIA

In order to prevent TIA, you should stop smoking and drinking alcohol.

With a quick reaction of the patient to the symptoms that have arisen, his emergency hospitalization and adequate emergency therapy, the symptoms of TIA undergo a reverse development, the patient returns to his usual rhythm of life. In some cases, TIA transforms into cerebral infarction or ischemic stroke, which significantly worsens the prognosis, leads to disability and even death of patients. The advanced age of the patient, the presence of bad habits and serious somatic pathology - risk factors such as hypertension, diabetes mellitus, severe atherosclerosis of the cerebral vessels, as well as the duration of neurological symptoms of TIA for more than 60 minutes contribute to the transformation of TIA into a stroke.

A transient ischemic attack (TIA) is a short-term disruption of the blood supply to the brain that usually lasts no more than sixty minutes and does not lead to a cerebral infarction.

TIA, like ischemic stroke, is caused by the fact that some part of the brain does not receive blood at all or does not receive enough blood for normal nutrition. Unlike a stroke, it lasts much less in time, the symptoms go away on their own and are not fatal. However, it should be remembered that without appropriate treatment of a transient ischemic attack, the risk of developing a stroke in a very short time increases significantly.

It is difficult to say how common this disease is, since often patients do not seek help. Short-term neurological symptoms, which also go away on their own without any treatment, are considered not particularly dangerous by them, which is fundamentally wrong.

Causes and predisposing factors

Transient ischemic attack has almost the same causes as a stroke. A thrombus or atherosclerotic plaque clogs the lumen of the vessel, preventing blood from moving further along it, and the part of the brain that was supplied by this vessel does not receive nutrients. In this case, a TIA or a stroke will develop, depending on the diameter of the clogged vessel, the place where it is blocked, the time of development of ischemia and other factors, some of which are still not fully understood.

TIA sometimes occurs against the background of diseases that can cause blockage of blood vessels with blood clots and plaques:

Atherosclerosis;
Infective endocarditis - inflammation of the inner lining of the heart;
Atrial fibrillation;
myocardial infarction;
Aneurysm of the left ventricle;
Artificial ;
atrial myxoma;
Significant blood loss;

And some other pathological conditions.

In addition, there are some factors that increase the risk of developing a TIA:

Age of the patient - transient ischemic attack occurs more often in elderly and senile people;
Constant increase in blood pressure;
Increased cholesterol levels in the blood - cholesterol is deposited on the walls of blood vessels and can clog their lumen. Plaques can come off and migrate through the vessels, sooner or later getting stuck where they can no longer pass;
Smoking;
The use of alcoholic beverages;
Diabetes;
heart disease;
Obesity;
Sedentary lifestyle.

Symptoms

The symptoms of a transient ischemic attack come on suddenly and get worse quickly, usually within minutes or even seconds. Most often they last no more than an hour, in rare cases - several hours, but they certainly pass within a day. It depends on which area of the brain the blood supply was disturbed. Here is their list:

Dizziness;
Nausea, which may be accompanied by vomiting;
Numbness of the face and hands;
There may be loss of vision in one eye, which resolves fairly quickly. This is due to the fact that the blood supply to the ophthalmic nerve is disturbed;
Mild paresis of one arm or entire side of the body, although these symptoms can sometimes be more severe
Perhaps a combination of visual impairment in one eye with hemiparesis of the opposite limbs. For example, the right eye and the left arm and leg;
Speech impairment - a person can either speak poorly himself or have difficulty understanding the speech of an outsider;

An unusual symptom of TIA is transient global amnesia. It is characterized by the fact that a person suddenly loses short-term memory, while remembering older events well. The patient is conscious, understands who he is, but may not remember where he is. Such attacks last from several minutes to several hours, after which the memory is fully restored. This symptom is quite rare and may recur every few years. Why this happens is still unknown.

Transient ischemic attacks may recur frequently or occur only once or twice. If they are rare, patients often do not attach importance to them and do not go to the doctor, so TIA diagnoses are often made retrospectively when an anamnesis is collected from a person who has had a stroke.

A stroke very often develops within a week after a TIA, left without proper treatment. The risk of its occurrence persists for five years, especially in the first few months. The prognosis is slightly better if the TIA only presents as transient blindness in one eye.

Differential Diagnosis

Since the symptoms of TIA are similar to some other diseases, differential diagnosis is important for proper treatment.

Transient ischemic attack should be distinguished from diseases such as epilepsy, multiple sclerosis, migraine, brain tumors, Meniere's disease and some others. This is important because the treatment of TIA is different.

An epileptic seizure usually begins in adolescence, while TIA is more common in older people. It starts suddenly and lasts no more than 5-10 minutes. Their twitching joins the paresis of the limbs. Often seizures are accompanied by loss of consciousness. The EEG is important for diagnosis in this case, since it shows changes typical of epilepsy.

The debut of multiple sclerosis also begins in younger people. Symptoms develop gradually and appear for more than a day.

Migraines - may, like TIAs, be accompanied by similar neurological symptoms. Migraine most often first manifests itself in young people, but there are cases of its onset in the elderly. It develops, unlike TIA, slowly, lasting several hours or even days. It is often combined with the usual visual disturbances for migraines, the so-called migraine aura: flashes of light or colored zigzags before the eyes, blind spots.

Meniere's disease, benign paroxysmal positional vertigo, vestibular neuronitis - the symptoms of these diseases are similar to those of transient ischemic attacks, but they do not have double vision, sensory disturbances and other signs of damage to the brain stem.

Some brain tumors, small hemorrhages in the brain, subdural hematomas do not differ in any way from TIA in terms of symptoms. In this case, only computed tomography and magnetic resonance imaging help to make the correct diagnosis.

Diagnostics

Since very often patients do not pay attention to transient disturbances of well-being and do not seek help in time, attacks of transient ischemic attack are clarified already at the time of filling out the medical history and collecting anamnesis, when any complication has occurred. Questioning the patient about the symptoms of the disease should be given special importance, since TIA attacks are fleeting and often occur at home, without medical supervision.

For the appointment of the correct treatment of transient ischemic attacks and the prevention of strokes, timely diagnosis of TIA is important.

Methods that allow you to identify disorders of the blood supply to the brain, as well as the localization of difficulties for the passage of blood:

CT and MRI - they are important not only for differential diagnosis, to distinguish TIA from diseases similar in symptoms, but also in order to rule out cerebral infarction. With TIA, computed tomography and magnetic resonance imaging most often do not show any abnormalities.
Functional MRI - it can detect small foci of cerebral infarction even with TIA, especially if the attack lasted more than an hour. These patients have an increased risk of cerebral infarction.
Palpation, as well as ultrasound of the blood vessels of the head and neck;
Rheoencephalography.
Cerebral angiography - This is usually performed before preparing the patient for surgery to more accurately confirm the location of a blood clot that interferes with blood flow.

In addition, other studies are being carried out:

Detailed analyzes of urine and blood;
Coagulogram - a study of blood clotting. Increased coagulation is dangerous by the risk of blood clots and blockage of blood vessels, as well as atherosclerotic plaques;
Blood chemistry;
Measurement of blood pressure on both arms;
Ultrasound of the heart is performed in patients who have any heart disease, and also if there is a suspicion that TIA has a cardioembolic cause;
EEG to rule out epilepsy;
Examination of the fundus.

All people who have had a history of transient ischemic attack, even if it was only once or twice, should be screened.

If necessary, the diagnosis of an attack may include a consultation with doctors of a different profile: cardiologists, ophthalmologists, vascular surgeons, endocrinologists and other doctors according to indications.

Treatment

Treatment of a transient ischemic attack should be started as early as possible. Patients are urgently hospitalized in the intensive care unit, where they should be given emergency care. Be sure to prescribe bed rest and monitor blood pressure. The patient is in intensive care for at least four hours, and according to indications longer, then he is transferred to the neurology department for further treatment.

Increased blood pressure is reduced in such a way as to exclude its fluctuations. For this, various groups of drugs are prescribed:

ACE inhibitors (captopril, enalapril).
Beta-blockers (propranolol, esmolol).
Vasodilators (sodium nitroprusside).
Calcium channel blockers (amlodipine).
Diuretics (indapamide, hydrochlorothiazide).
Angiotensin II receptor blockers (losartan, valsartan).

In addition to them, other medicines are also used:

Antiplatelet drugs (aspirin, clopidogrel, dipyridamole, etc.) - their appointment is extremely important for the prevention of ischemic stroke and other cardiovascular diseases. These drugs reduce platelet aggregation, which prevents blood clots from forming.
Indirect anticoagulants (warfarin, xarelto) - they are prescribed for atrial fibrillation, if a thrombus is found in the ventricles of the heart, with a recent myocardial infarction and other pathologies according to indications. Taking warfarin requires regular blood tests to monitor clotting.
Statins are prescribed to lower cholesterol levels in order to avoid the formation of cholesterol plaques and blockage of blood vessels.
Neuroprotectors (magnesium sulfate, glycine, actovegin, cerebrolysin) - are used to protect the brain and improve its nutrition, which is extremely important in case of circulatory disorders;
Patients with diabetes mellitus, as well as with an increase in blood sugar levels, need to prescribe insulin and monitor sugar levels.

In some cases, surgical treatment may be urgently prescribed.

Most often, patients seek medical help after the signs of TIA have disappeared, and their treatment is not aimed at eliminating the attack itself, but at preventing complications: ischemic strokes and diseases of the cardiovascular system.

In addition to drugs, non-drug prevention is of great importance:

Rejection of bad habits

People who have had a TIA need to give up bad habits as soon as possible. Some believe that in old age it is too late to change anything, giving up cigarettes and alcohol will not change anything, but it has been proven that this is not the case. Even in those who have smoked for many years, the risk of stroke is significantly reduced after quitting smoking. Stopping drinking also reduces the risk of complications, even in people who have consumed large amounts of alcoholic beverages in the past.

Balanced diet

It is necessary to introduce a sufficient amount of vegetables and fruits into your diet, reduce the consumption of foods containing cholesterol. If there are problems with weight, it is also necessary to reduce the calorie content of food. Bringing weight back to normal is an important condition for the prevention of strokes and heart attacks.

Active lifestyle

A sedentary lifestyle and low physical activity contribute to obesity and high blood pressure, so it is necessary to load the body with physical exercises. However, it is necessary to ensure that the loads are not too great, the heart must cope well with them. Very useful walks in the fresh air.

Regular examinations and treatment of concomitant diseases

Patients who have had a transient ischemic attack at least once should regularly visit doctors, monitor cholesterol, blood clotting, and blood pressure. It is unacceptable to arbitrarily stop the prescribed treatment. The treatment of arterial hypertension, diabetes mellitus, and cardiovascular diseases is of great importance.

A person has the ability to feel, think, move, experience emotions, see, hear thanks to the work of the brain. The brain consists of two hemispheres, the brainstem and the cerebellum. All vital centers (respiratory, vasomotor and others) are concentrated in the brain stem. The cerebellum is responsible for balance, muscle tone and coordination. The cerebral hemispheres are divided by convolutions into 4 lobes. In the cerebral hemispheres, the cortex and subcortex are distinguished. The subcortex contains nuclei that regulate many body functions.

The cerebral cortex is a collection of billions of nerve cells in which the analysis and synthesis of all signals entering the brain, the processing of information, and the organization of the activities of all organs and systems take place. The frontal lobe of the cortex is responsible for motor behavior, the organization of voluntary movements, logic, and speech. The centers of vision are located in the occipital zone; visual images are recognized and analyzed here.

The center of hearing is located in the temporal lobe. The parietal lobe is responsible for sensitivity. This is how the structure and functions of the brain can be simplified. But in order to fully function, the brain must receive enough oxygen. Nutrients and oxygen are supplied to brain cells by 4 main arteries: the right and left internal carotid and vertebral arteries. These arteries have numerous branches, so that normally not a single brain cell remains deprived of oxygen.

But, there are situations when the blood flow in the vessels of the brain can decrease or even stop. Neurons begin to experience oxygen "hunger", brain cells are still alive, but cannot fully function, for this reason ischemia develops. This phenomenon in neurology is called "transient ischemic attack".

2Why does a transient ischemic attack occur?

What are the reasons for the cessation of blood flow in the cerebral vessels? Their spasm or blockage (partial or complete). Transient ischemic attack often develops due to vascular atherosclerosis. Atherosclerosis is the most common cause of cerebrovascular accidents. Atherosclerosis is the deposition of plaques in the vessels from "bad" cholesterol, triglycerides. These plaques, growing, are able to clog the vessel, then thrombosis occurs, or they can even come off with the development of an embolism.

In addition to atherosclerosis, the following causes of transient ischemia are distinguished:

arterial hypertension
inflammation of the vascular wall (endarteritis)
heart diseases (arrhythmias, ischemic heart disease, cardiomyopathy)
endocrine diseases
pathological tortuosity of blood vessels
osteochondrosis of the cervical spine.

In these diseases, due to the formation of a thrombus or vasoconstriction, cerebral ischemia may develop due to starvation of neurons in conditions of oxygen deficiency. If in the next 5-10 minutes the blood flow in the vessel is restored, then the brain cells will not have time to die, and their structure and functions will be restored, if not restored, the consequences are irreversible: the cells die.

Transient ischemic attack turns into ischemic stroke, the neurological symptoms of which are permanent. It follows from this that a transient ischemic attack is a temporary violation of cerebral circulation, which has two outcomes: recovery (restoration of neurons and complete disappearance of neurological symptoms) or transition to an ischemic stroke (death of neurons and aggravation of neurological symptoms).

Symptoms of cerebral ischemia are more typical for people who are overweight, smokers, abuse alcohol, lead a sedentary lifestyle. These are the so-called risk factors, which, together with provoking diseases, cause ischemic circulatory disorders in the brain.

3How does a transient ischemic attack manifest itself?

The symptoms are varied and depend on which area of the brain has ceased to receive oxygen. Patients may complain of dizziness, unsteadiness when walking, sensory disturbance in the lower or upper extremities, they often say that the arms or legs are “not mine”, “do not obey”, there may be immobility of the upper or lower extremities, or half of the body, numbness hands or feet.

Speech may be disturbed, it becomes slurred, there is a loss of memory, disorientation in time, space, and one's own personality. There are complaints of headache, nausea, vomiting, blurred vision, loss of vision in one eye, change in color perception, flickering of "flies", flashes of light before the eyes. There may be loss of consciousness.

These symptoms can be expressed to varying degrees, it is important to remember them, because often a person with symptoms of a transient ischemic attack, who became ill on the street or in a public place, is mistaken for a person in a state of intoxication and passes by without providing first aid .

With the restoration of cerebral blood flow in a short time, all symptoms disappear without a trace. If blood flow cannot be restored, a stroke develops. A person becomes disabled or dies.

4How to help a person with a transient ischemic attack?

If you suspect that a person has symptoms of transient cerebral ischemia, you should immediately call an ambulance. Communicate clearly and distinctly to the ambulance dispatcher your suspicions and what symptoms you are experiencing. Before the ambulance arrives, ensure the patient is in a horizontal position, create an influx of fresh air.

If the patient is vomiting, turn his head to the side and hold it in this position when vomiting so that he does not choke on vomit. Measure blood pressure and pulse, record the data and show the emergency doctor. Specify if the patient is conscious, what he was ill with and what medications he took, what reasons could cause deterioration in well-being, also tell this information to the doctor.

Do not give the patient any drink or food, as he is likely to have impaired swallowing function, which may cause suffocation. Remember that the effectiveness of further treatment depends on the effectiveness of further treatment of the patient's life.

5Diagnosis of transient ischemic attack

All patients with suspected ischemic cerebrovascular accident should be hospitalized in a hospital. Even if the symptoms and signs have passed by the time the ambulance arrives, and the patient or others say that they have taken place, hospitalization for 1-2 days is necessary for observation. Since the risk of developing the consequences of ischemic stroke is high.

After complaints are clarified, the reasons for the deterioration of well-being, an anamnesis is collected, for an accurate diagnosis and treatment, the doctor proceeds to a neurological examination. Patients often have disorders of sensitivity, coordination, increase or loss of peripheral reflexes, meningeal symptoms, there may be paresis or complete immobility of the limbs or half of the body.

To help the doctor, a laboratory examination is carried out: general clinical blood and urine tests, a blood clotting test, a biochemical blood test with the determination of cholesterol, lipid spectrum, atherogenic coefficient, blood glucose). ECG, electroencephalogram, ultrasound with dopplerography of neck vessels, computed tomography of the brain, MRI with angiography are performed.

6Treatment and prevention

Treatment of an ischemic attack of the brain is aimed at preventing possible consequences - ischemic stroke and eliminating the causes that caused the attack. If the patient no longer has signs of a transient ischemic attack, medical supervision, examination of the patient, correction of the treatment of arterial hypertension, and concomitant diseases are still necessary.

If increased blood clotting is detected, anticoagulants and antiaggregants are prescribed. Statins are prescribed for high cholesterol levels. To improve blood circulation in the vessels of the brain, nootropic drugs are used in the treatment, as well as infusion therapy intravenously.

A sharp decrease in blood pressure with its initially high numbers is unacceptable, since this can aggravate the signs of an ischemic attack of the brain and cause a deterioration in well-being. If a patient has a pathological tortuosity of the vessels of the neck during the examination, which affects the blood supply to the brain, an angiosurgeon should be consulted to resolve the issue of surgical treatment.

Prevention of ischemic circulatory disorders of the brain is to eliminate risk factors - the reasons why an ischemic attack can recur and lead to a stroke.

It requires a complete rejection of nicotine and alcohol, a diet with a restriction of animal fats, fatty, fried, spicy, salty, smoked foods.

The diet should be enriched with plant foods, seafood, fiber. It is necessary to control the level of cholesterol, blood coagulation, blood glucose, body weight. Adequate physical activity should be ensured, a sedentary lifestyle is unacceptable.

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TIA symptoms

In most cases, transient ischemic attacks have symptoms that warn of an impending catastrophe. These include:

frequent headaches;
sudden attacks of dizziness;
blurred vision (darkening, "goosebumps" before the eyes);
numbness of body parts.

The picture of a transient ischemic attack is manifested by an increasing headache of a certain localization. Dizziness is accompanied by nausea and vomiting, there may be disorientation or confusion. The severity of the condition is determined by the duration of cerebral ischemia and the level of blood pressure. The clinical picture depends on the location and degree of vascular pathology.

TIA in the carotid system

Typical symptoms develop within 2 to 5 minutes. Circulatory disorder in the carotid artery has characteristic neurological manifestations:

weakness, difficulty in moving the limbs on one side;
loss or decrease in sensitivity of the right or left half of the body;
speech impairment from complete absence to minor difficulties;
sudden complete or partial loss of vision.

Features of the defeat of the carotid artery

As a rule, the transient occurrence of an ischemic attack in the carotid artery system has objective symptoms:

weakening of the pulse;
noise when listening to the carotid artery;
pathology of retinal vessels.

Typical focal symptoms of brain damage in the pathology of the carotid artery. A transient ischemic attack manifests itself with specific neurological signs, namely:

facial asymmetry;
violation of sensitivity;
pathological reflexes;
pressure fluctuations;
narrowing of the vessels of the fundus.

The pathology of the carotid artery is also manifested by non-brain symptoms: heaviness in the chest, interruptions in the work of the heart, lack of air, tearfulness, convulsions.

TIA of the vertebrobasilar system

The clinical picture of a transiently developed ischemic attack is demonstrated by both cerebral and specific signs. They depend on the location and degree of damage to the main and vertebral arteries, as well as their branches. The patient's condition is determined by the development of collateral circulation, the degree of hypertension and the presence of concomitant diseases.

Transient ischemic attack in the vertebrobasilar basin accounts for 70% of all cases of TIA. This frequency is due to the slow flow of blood through the vessels of this brain area.

Movement disorders can be not only unilateral, but also of various localization. Cases of paralysis of all limbs are known. The degree of damage is different: from weakness to paralysis.

Sensitivity disorders are more often unilateral, but can also change their localization.
Complete or partial loss of vision.
Dizziness is accompanied by double vision, impaired swallowing and speech. Vomiting often occurs.
Attacks of a short fall without loss of consciousness.
Sensation of circular rotation of objects, unsteadiness of gait. The dizziness is aggravated by turning the head.

Isolated symptoms are not signs of a TIA. The diagnosis of a transient ischemic attack can only be made with their combination. If there are symptoms listed in points 1 and 2, then the patient has a transient ischemic attack with all the consequences.

Diagnostics

All patients who develop a transient ischemic attack are immediately taken to the clinic. Early diagnosis and timely treatment will "block" the path to a stroke. Patients are delivered to the neurological department, equipped with the necessary diagnostic complex.

Clinical Examination Scheme

The list of mandatory diagnostic methods for transient current ischemic attack includes:

auscultation of the carotid arteries;
measurement of blood pressure;
a blood test with an expanded leukocyte formula;
blood lipid spectrum: cholesterol and triglyceride levels;
the state of the coagulation system;
Ultrasound of the vessels of the head and neck;
electroencephalography;
MRI with angiography;
computer tomogram.

All patients should undergo examinations, because in the future the consequences can be irreversible and lead to disability or death. The clinic of a transient ischemic attack can mask a number of serious diseases.

Differential Diagnosis

Some of the symptoms that characterize the transient course of an ischemic brain attack are similar to those of other neurological diseases, namely:

A migraine attack is accompanied by visual, speech disorders;
After an epileptic seizure, a period of muffled consciousness begins with a decrease in sensitivity;
Diabetes mellitus is manifested by various neurological symptoms: paresthesia, dizziness, loss of consciousness;
Multiple sclerosis may debut with TIA symptoms;
In Meniere's disease, attacks are accompanied by vomiting, dizziness.

After an objective clinical examination, differential diagnosis, you can proceed to reasonable treatment.

Treatment

Medical care is aimed at stopping the ischemic episode and preventing cerebral stroke. Specific treatment of transient ischemic attack is to restore: cerebral blood flow, optimal blood pressure, heart function, anticoagulant system. To achieve the goal, the following drugs are used:

antihypertensive therapy: beta-blockers, clonidine, labetalol;
to restore the blood circulation of the brain, cavinton, vinpocetine, ceraxon are used;
rheological properties are restored with trental, rheosorbilact;
statins to normalize cholesterol levels;
preparations tonic vessels of the brain - troxevasin, venoruton.

In addition to taking medications, the patient should know that a transient current episode of an ischemic attack will not occur if all preventive measures are followed.

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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 block and even atrial myxoma);
Sudden arterial 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 companions?) 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 basin, 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 undergo all the examinations provided for in the protocol, and besides, there is a risk of a re-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.

All people who have had a TIA at least once should undergo such an examination, 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:

migraine with aura gives similar symptoms in the form of speech or visual disturbances and hemiparesis;
Epilepsy, an attack of which can result in a disorder of sensitivity and motor activity, and even tends to sleep;
Transient global amnesia, characterized by short-term memory disorders;
Diabetes can “afford” any symptomatology, where TIA is no exception;
The initial manifestations of multiple sclerosis, which confuse doctors with such signs of neurological pathology similar to TIA, well imitate a transient ischemic attack;
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 adrenergic blockers (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 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 a recurrence of TIA and an 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 (swimming is good to do), 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.

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Causes and risk factors for TIA

Most often, transient ischemic attacks occur in patients with cerebral atherosclerosis, high blood pressure, and their combination. A much smaller role is given to such etiological factors as diabetes mellitus, vasculitis, compression of the arteries by osteophytes in osteochondrosis of the cervical spine.

Other, rarer, causes of TIA include:

thromboembolic disorders in the vessels of the brain that occur as a result of cardiac arrhythmias, congenital and acquired heart defects, bacterial endocarditis, atrial fibrillation, prosthetic heart valve apparatus, intracardiac tumors, etc.;
a sudden drop in blood pressure, which leads to acute hypoxia of the brain tissue (shock of any origin, Takayasu's disease, orthostatic hypotension, bleeding);
damage to the cerebral arteries of an autoimmune nature (systemic vasculitis, Buerger's disease, Kawasaki syndrome, temporal arteritis);
pathological disorders in the cervical spine (osteochondrosis, spondylarthrosis, spondylosis, intervertebral hernia, spondylolisthesis);
disorders in the blood system, which are accompanied by an increased tendency to thrombosis;
migraine, especially the clinical variant with aura (the risk of this variant of TIA is significantly increased in women who take oral contraceptives);
dissection (dissection) of cerebral arteries;
congenital defects of the vascular apparatus of the brain;
malignant neoplasms of any localization;
Moyamoya disease;
deep vein thrombosis of the lower extremities.

Risk factors for developing TIA:

arterial hypertension;
atherosclerosis and hyperlipidemia;
diabetes;
hypodynamia;
excess body weight;
bad habits;
all the above diseases and pathological conditions.

Important to remember! People who are at risk of developing TIA, and therefore ischemic stroke, should be informed of the possible risk and take all possible preventive measures.

The essence of the disease

There are several mechanisms for the development of acute disorders of cerebral circulation and in particular TIA. But the most common is the following.

Microemboli and atheromatous masses that form in the carotid and vertebral arteries (they are the result of the breakdown of atherosclerotic plaques) can move with the blood flow into smaller vessels, where they cause blockage of the arteries. Most often, the terminal cortical branches of the arterial vessels suffer. In addition to blocking the lumen of the arteries, they cause irritation and spasm of the vascular walls. Since such masses by themselves can rarely cause a complete cessation of blood circulation distal to the site of localization, the second mechanism plays a major role in the development of TIA symptoms.

These platelet and atheromatous masses are very soft in structure and therefore quickly amenable to dissolution. After that, the spasm of the artery is eliminated and the blood flow in this area of the brain is normalized. All symptoms are gone. Also, these microemboli can be of cardiogenic origin or be the result of problems in the blood coagulation system.

This process itself lasts only a few seconds or minutes, but pathological signs sometimes last up to 24 hours. This is due to edema of the vascular wall due to its irritation, which disappears within a few hours after the acute period.

But, unfortunately, the development of the disease is not always so favorable. If the dissolution of blood clots and vasospasm is not eliminated on its own within 4-7 minutes, but in neurons that are under hypoxic conditions, irreversible changes occur and they die. A stroke develops. But, fortunately, such strokes have a relatively favorable prognosis, since they are never extensive.

TIA symptoms

Signs are most often manifested by focal nerve signs. Much less often, cerebral symptoms develop, such as headache, vertigo, bouts of nausea with vomiting, impaired consciousness.

Symptoms of TIA depend on the localization of atherosclerotic plaques - in the carotid or vertebrobasilar vascular bed.

TIA in the vertebrobasilar vascular pool

This type of TIA is the most common and accounts for up to 70% of transient ischemic attacks.

TIA symptoms:

bouts of systemic dizziness;
vegetative-vascular disorders;
noise and ringing in the head and ears;
bursting headache in the back of the head;
bouts of prolonged hiccups;
pallor of the skin;
increased sweating;
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);
nystagmus;
violation of statics and coordination of movements;
drop attacks - attacks of a sharp fall without loss of consciousness.

TIA in the carotid vasculature

It is manifested mainly by focal neurological symptoms, most often these are sensory disorders. Sometimes the symptoms are so miserable that the patient does not even realize that something is wrong with his body.

TIA symptoms:

numbness of some parts of the body, most often from one limb, but can also proceed according to the type of hemianesthesia (damage to the arm and leg on one half of the body);
development of motor disorders in the form of monoparesis or hemiparesis (damage to one limb or arm and leg on one half of the body);
if the lesion is localized in the left hemisphere, then speech problems develop - aphasia, cortical dysarthria;
seizures;
blindness in one eye.

The duration and reversibility of TIA symptoms varies, from a few seconds to 24 hours. But, nevertheless, an accurate diagnosis can be made only after some time. The fact is that with TIA, according to additional research methods (MRI and CT), no pathological foci are found. If this happens, then we should talk about a stroke, even if all the signs disappeared during the first day after the onset. In medicine, there is a special term for this type of circulatory disorder in the brain tissue - “small stroke”.

Video transmission and signs of a stroke:

Severity of TIA

Depending on the dynamics of the disease, there are 3 degrees of severity of transient ischemic attack:

Light- focal neurological signs are present for up to 10 minutes, pass on their own, no consequences remain.
Medium- symptoms last from 10 minutes to several hours, disappear on their own or under the influence of therapy without consequences.
heavy- neurological symptoms are present from several hours to 1 day, pass under the influence of specific therapy, but after an acute period, consequences are observed in the form of minor neurological symptoms that do not affect the quality of life, but are detected upon examination by a neurologist.

Depending on the frequency of attacks, there are:

rare TIA - no more than 1-2 times a year;
with an average frequency - 3-6 times a year;
frequent - 1 time per month or even more often.

Diagnostics

Diagnosis of ischemic transient attack presents some difficulties. Firstly, people do not always pay attention to the symptoms of a disorder, considering them to be a common condition. Secondly, the differential diagnosis between ischemic stroke and TIA in the first hours is very difficult, since the symptoms are very similar, and there may still be no changes on the tomography, as a rule, with a stroke they are clearly visible only 2-3 days from the development pathology.

Used for diagnosis:

detailed objective examination of the patient, collection of complaints and study of the medical history, determination of risk factors for the development of TIA;
a full range of laboratory blood and urine tests, which must include a lipid profile, the study of blood coagulation, a biochemical blood test;
ECG and ultrasound of the heart to detect cardiopathology;
Ultrasound of the vessels of the head and neck;
magnetic resonance or computed tomography of the brain;
electroencephalography;
blood pressure monitoring;
other methods necessary for making the main diagnosis.

Important to remember! Since the accurate diagnosis of transient ischemic attack is retrospective, all patients with focal neurological symptoms are subject to hospitalization and treatment according to stroke protocols, because these conditions can be distinguished only after 2-3 days.

Principles of treatment

The first step is to determine if a transient ischemic attack requires treatment. Many experts argue that TIA therapy is not needed at all, because all the signs go away on their own. This is true, but there are 2 controversial points.

The first. TIA is not an independent disease, but a consequence of a primary pathology. Therefore, all therapeutic measures should be directed to the therapy of the diseases that caused the violation, as well as to the primary and secondary prevention of the development of acute cerebrovascular accidents.

Second. Treatment of TIA should be carried out according to all medical protocols for managing patients with ischemic stroke, since, as already mentioned, it is simply impossible to distinguish between these two conditions in the first hours.

Basic therapeutic measures:

mandatory hospitalization in a specialized neurological department;
specific thrombolytic therapy (the administration of drugs that can dissolve existing blood clots) is 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 the formation of blood clots (heparin, enoxaparin, deltaparin, fraxiparin, etc.);
medicines that normalize blood pressure when it rises (beta-blockers, ACE inhibitors, sartans, diuretics, calcium channel blockers);
antiplatelet agents that prevent platelets from sticking together and forming blood clots (clopidogrel, aspirin);
drugs that have neuroprotective abilities - protect nerve cells from damage, increase their resistance to hypoxia;
antiarrhythmic drugs for cardiac arrhythmias;
medicines that lower blood cholesterol levels - statins (atorvastatin, rosuvastatin, simvastatin, etc.);
symptomatic therapy and restorative agents.

Surgery

Surgical treatment can be prescribed for atherosclerotic lesions of extracranial vessels, in particular carotid. There are three types of surgeries:

carotid endarterectomy, when an atherosclerotic plaque is removed from the lumen of the vessel along with the inner part of its wall;
stenting of narrowed arteries;

Symptoms of cerebral ischemia in adults

Transient ischemic attack (TIA) was formerly known as dynamic or transient, 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 -.

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 an ischemic stroke, but for that it is an attack in order to attack only 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 (vasoconstriction, decaying atheromatous plaques and cholesterol crystals can be carried with the bloodstream into smaller vessels in diameter, contribute to them, resulting in ischemia and microscopic foci of tissue necrosis);
Thromboembolism resulting from many heart diseases (, congestive, and even);
Arising suddenly, inherent in the disease;
(obliterating);
cervical spine with compression and angiospasm, the result of which is (ischemia in the basin of the main and vertebral arteries);
Coagulopathy, and. 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;

In addition, the eternal prerequisites (or satellites?) of any vascular pathology contribute well to the onset of a cerebral ischemic attack: diabetes mellitus, 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:

Sometimes in patients there is a pronounced 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.

Diagnostic measures

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 ();
Electroencephalogram (EEG);
cervical and cerebral arteries;
Magnetic resonance;

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:

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

Does a transient ischemic attack require treatment?

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

Increased sympathetic tone is reduced by the use of, 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.

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, and (ACE). 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 corrected and .

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.

Transient ischemic attack in vbb. Transient ischemic attack (TIA) of the brain: signs and treatment

Types of transient ischemic attack

The reasons

Symptoms

Treatment

Treatment in a hospital

Prevention

TIA and risk of ischemic stroke

Causes and mechanisms of development of transient ischemic attack

TIA classification

Clinical manifestations of transient ischemic attacks

Diagnosis of transient ischemic attacks

Differential diagnosis of transient ischemic attacks

Principles of treatment of transient ischemic attacks

Prevention of transient ischemic attacks

Prognosis for TIA

Causes and predisposing factors

Symptoms

Differential Diagnosis

Diagnostics

Treatment

2Why does a transient ischemic attack occur?

3How does a transient ischemic attack manifest itself?

4How to help a person with a transient ischemic attack?

5Diagnosis of transient ischemic attack

6Treatment and prevention

TIA symptoms

TIA in the carotid system

Features of the defeat of the carotid artery

TIA of the vertebrobasilar system

Diagnostics

Clinical Examination Scheme

Differential Diagnosis

Treatment

Causes of transient ischemia

Signs of a TIA

Diagnostic measures

Differential Diagnosis

Does a transient ischemic attack require treatment?

Prevention and prognosis

Causes and risk factors for TIA

The essence of the disease

TIA symptoms

TIA in the vertebrobasilar vascular pool

TIA in the carotid vasculature

Severity of TIA

Diagnostics

Principles of treatment

Surgery

Causes of transient ischemia

Signs of a TIA

Diagnostic measures

Differential Diagnosis

Does a transient ischemic attack require treatment?

Prevention and prognosis

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