Transient ischemic attack in the right carotid pool. Dangers of transient ischemic attack and preventive measures. Causes of TIA in children

Everyone knows about such a disease as a stroke. Much less people are aware of the ischemic attack of the brain, which is also dangerous.

Etiology and pathogenesis

An acute circulatory disorder in the brain is not always diagnosed, as it proceeds very quickly, and its symptoms disappear within an hour after the onset of the attack. Ischemic attack is called transient (TIA), which means "passing imperceptibly, transient." Therein lies its danger.

TIA is caused by damage to a segment of the brain due to a decrease or complete cessation of blood flow due to partial blockage of blood vessels.

Since this condition lasts no more than 1 hour, brain tissue is not damaged as deeply as in a stroke.

Causes leading to cerebral ischemia include:

All factors provoke a narrowing of the lumen of the arteries and vessels up to a complete blockage of the lumen.

Symptomatic picture

There are two forms of TIA, depending on the location of the focus with impaired blood circulation. If the failure occurred in the carotid arteries, then they talk about a carotid attack. When the blood supply is stopped due to damage to the vascular pool formed by the vertebral arteries, vertebrobasilar (VBB) ischemia is diagnosed.

With an ischemic attack of the brain, the symptoms are due to the indicated types.

Common symptoms of the disease include:

The disease begins suddenly, and its symptoms increase at lightning speed to a maximum within a few seconds or minutes and persist for another 10 minutes, after which the patient's condition returns to normal.

Features of the disease

Failures of cerebral circulation can be repeated several times in a row for weeks and months, or occur once or twice in a lifetime. If the attack proceeds in a mild form, then the clinical picture is blurred, and the patient does not go to the doctor. With more severe symptoms, the consequences of TIAs are severe, with ten to forty percent of attacks resulting in a stroke. The risk is especially high in the first week after an attack of cerebral ischemia.

A lethal outcome is likely within the first year after a TIA in 10% of patients and five years in 40%.

In fact, an ischemic attack is a harbinger of a stroke.

In men from 60 to 70 years old and in women of 75-85 years old, the disease is most likely against the background of cardiovascular pathologies and metabolic disorders.

Diagnostic measures

To make a diagnosis, the doctor asks the patient in detail about the symptoms. After collecting an anamnesis, a blood test is performed to determine:

creatinine, sodium and potassium;
glucose;
plasma coagulation factors;
cholesterol.

Other physiological fluids are also being investigated.

To exclude pathologies of the heart and lungs, an ECG and radiography are performed.

If the doctor is in doubt about the diagnosis, selectively prescribe:

The symptoms of TIA are similar to diseases accompanied by short-term neurological disorders, and the doctor's task is to differentiate them. These pathologies include:

After a thorough examination of the clinical picture, the patient is recommended further examination.

Definitions of the cause of TIA

People who have had a cerebral ischemic attack are at risk of stroke. Therefore, procedures are carried out to determine the cause of the attack.:

CT and MRI do not always detect ischemic foci, but in 25% of cases it is possible to determine cerebral infarction.

Treatment of the disease

Only 40% of patients go to the clinic after an attack. A neurologist works with them.

Upon completion of the complex of diagnostic measures, treatment is prescribed to stop ischemia and restore normal blood circulation.

Medical treatment

To restore blood flow, ticlopidine, dipyridamole, aspirin are prescribed. If the attack was caused by blockage of the vessel, then indirect anticoagulants are used: sodium warfarin, ethyl biscum acetate, phenindione.

To thin the blood, saline solutions, a ten percent glucose solution, and dextran are dripped. If the cause of TIA was a sharp rise in blood pressure against the background of hypertension, the doctor prescribes drugs to normalize it: atenolol, captopril, nifedipine, diuretics. Vinpocetine, cinnarizine are taken to improve cerebral circulation.

When attacked, neurons die due to disruption of metabolic processes. To stop cell death, the use of metabolites and cerebroprotectors is required. These include:

To relieve the main symptoms, take diclofenac (with severe headache); mannitol (with the onset of cerebral edema).

Physiotherapy procedures

Along with taking medications, the neurologist recommends a consultation with a physiotherapist, who may prescribe:

Depending on concomitant diseases, the patient is prescribed one procedure or several.

Preventive measures

To prevent a second attack or reduce the likelihood of its occurrence in people who have not yet experienced cerebral ischemia, it is necessary to make lifestyle changes:

With an increased level of cholesterol in the blood, as prescribed by a doctor, you should take drugs that reduce the amount of lipids (pravastatin, atorvastatin) for a long time.

If a pathology of the vessels supplying the brain is detected, surgical intervention is indicated:

endarterectomy - removal of plaques on the inner wall of the carotid artery;
microshunting;
arterial stenting.

Preventing a TIA will help prevent a stroke.

A cerebrovascular accident that has a transient character is a cerebral ischemic attack, which in sixty minutes can develop into a stroke that damages brain tissue. Another more common name for this disease is transient ischemic attack of the brain (TIA).

Such an attack is similar to a stroke, but its signs last a short time, after a while they completely disappear. leads to minor injury to the structural connections of the nerves. Injuries do not affect the future life of a person.

The circumstances leading to a deterioration in the blood flow in a certain place of the medulla are the causes of a transient ischemic attack:

the development of atherosclerosis, that is, a decrease in the lumen of the vascular system, due to thrombosis of the small vascular system with atheromatous clots and cholesterol structures, resulting in ischemia and small centers of death of tissue structures;
formed due to diseases of the heart muscle;
Sudden drop in blood pressure;
in the neck area, the result of which is ischemia;
coagulopathy, angiopathy and blood loss. Platelets that move along the blood stream are able to get stuck in a small artery, which turned out to be irresistible because the clot turned out to be large;
severe pain in the head;
high cholesterol;
alcoholism and smoking;
excess weight;
low physical activity.

The symptoms of a transient ischemic attack of the brain are directly dependent on the proportion in which there was a disorder in the supply of the brain with blood. It is due to the severity of this or that symptomatology that it is possible to determine the pool of arteries in which the violation took place.

The region of the vertebrobasilar basin is characterized by the following symptoms:

nausea with gag reflexes;
pronunciation disorder;
the face becomes numb;
temporary visual impairment;
lack of sensitivity and impaired coordination;
violation of temporal and spatial orientation.
The carotid pool has the following symptoms:
sensory disturbance;
speech disorder;
numbness and poor motor activity of the limbs or parts of the body;
lethargy;
desire to sleep;
soreness of the head with symptoms of meningitis.

Transient ischemic attack of the head occurs suddenly, and can quickly stop, so it is of great importance for the doctor to obtain information about the course of the disease.

Diagnosis of transient ischemic attack has certain difficulties, since the symptoms disappear, but the root causes remain.

Diagnosis of ischemia of brain activity is represented by the following methods:

palpation and listening to the pulsation of blood vessels in the neck, arms and legs, pressure measurement;
clinical and;
coagulogram;
electrocardiogram;
encephalogram;
rheoencephalography of the vascular system of the head;
ultrasonic dopplerography;

Another factor complicating diagnosis is the similarity of symptoms with other diseases: migraine, epilepsy, amnesia, diabetes, Meniere's disease.

Treatment

Many experts argue that transient ischemic attack does not need treatment. But, given that this is a serious disease that eventually leads to a stroke, the treatment of transient ischemic attack comes down to the need to treat the causes that cause this disease.

So, with elevated levels of harmful cholesterol, treatment is carried out through:

The increased tone of the sympathetic departments is lowered by adrenergic blockers, and the reduced tone is brought back to normal with special tinctures, a complex of vitamins containing potassium.
The activity of the parasympathetic site is adjusted with medicines based on belladonna, B vitamins, anti-allergy agents, and poor parasympathetic tone with potassium preparations, insulin.
For the vegetation system, grandaxin and ergotamine tablets will be useful.
treated with β-blockers, calcium antagonists and ACE inhibitors. Of great importance are drugs that improve the flow of blood through the veins and the metabolism carried out in the brain.
With reduced pressure in the vascular system of the medulla, drugs that have vein tonic properties, such as venoruton, troxevasin, anavenol, are used. A rather important role in preventive measures is played by the treatment of blood thinning disorders, which is corrected by antiplatelet and anticoagulant drugs.
In the treatment and prevention of ischemic stroke in the brain, the use of drugs that can improve the process of memorization has a positive effect: piracetam, which also includes antiplatelet functions, actovegin, glycine.
Mental disorders are cured with the help of tranquilizers, and the protective effect is obtained from the use of antioxidant and vitamin preparations.

Prevention

An ischemic attack in the brain has in the list of its consequences repeated attacks and the actual stroke condition. Therefore, preventive measures must be aimed at preventing the actual ischemic attack, so as not to worsen the formation of a stroke.

An important role in the treatment of ischemia is played by maintaining a healthy lifestyle, nutrition, physical activity.

The main principles of prevention of transient ischemic attack are:

refusal of cholesterol-containing food, alcohol, smoking;
moderate physical activity;
use of traditional methods of treatment.

All these activities will help the patient get rid of the symptoms of an ischemic attack, the prognosis of which is positive, unlike a stroke.

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 hypoglycemic 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 (dramatically 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.

According to epidemiological data, approximately 50 out of 100 thousand inhabitants of European countries develop a transient ischemic attack (TIA). Nosology refers to transient changes in the violation of cerebral blood supply, as the symptoms disappear, or significantly degrade about a day after the onset.

Statistics indicate a greater percentage of cerebral ischemia in women after 75 years of age and men after 65 years of age. TIA is rare in young people over 45 years of age.

What is a transient ischemic cerebral attack

The duration of ischemic manifestations depends on the location of the pathology. in the vertebrobasilar region (VBB, neck and brachial plexus) lasts several hours. Embolism, thrombosis of the anterior and posterior cerebral arteries causes symptoms up to 24 hours.

Transient cerebral ischemia is what some doctors consider to be the initial stage of a stroke. The difference lies only in the time interval of maintaining the clinic. Both nosological forms require a thorough diagnosis of the state of the brain within 60 minutes after the onset, since delay is life-threatening for the patient.

Transient attacks of ischemia significantly increase the risk of stroke within 48 hours after the first manifestations.

Percentage risk of cerebral stroke after a transient cerebral seizure:

For two days - 10%;
Three months - 10%;
Twelve months - up to 20%;
Five-year term - up to 12%.

Given the statistics, it is important to understand the need for careful diagnosis and proper treatment of TIA at an early stage. Timely assistance is an important step, but it is possible to prevent a stroke after an attack only by preventive procedures.

MRI of stroke and transient ischemic attack

Classification of transient cerebral ischemia according to ICD 10

The classification of an ischemic attack according to the international classification of the disease of the tenth revision is accompanied by a number of nosological forms:

Transient global amnesia - "G45.4";
Bilateral damage to the cerebral arteries - "G45.2";
Hemispheric carotid artery syndrome - code "G45.1";
Transient blindness - "G45.3";
Vertebrobasilar syndrome - "G45.0";
Other brain attacks - "G45.8";
Ischemic attack, unspecified - "G45.9".

The ICD 10 code for transient ischemic attacks is "G45".

The nosological form of cerebral microcirculation disorders should be determined immediately after the patient's admission, which will allow choosing a therapeutic tactic and methods of prevention.

The symptom of "transient blindness" is accompanied by the appearance of a "shutter" on one eye, which occurs suddenly or is formed after an irritant factor - a flash of light, exposure to the hot rays of the sun. Pathology may be accompanied by muscle cramps on the side opposite to the lesion. Possible loss of sensitivity of the skin.

Transient amnesia is characterized by loss of memory for short-term events. During an attack, a person loses orientation in the environment, performs stereotypical actions.

Causes of an ischemic attack

A common cause of transient cerebral ischemia is microemboli formed from primary atherosclerotic plaque. Formations consist of particles of cholesterol, platelet accumulations. After entering the cerebral arteries, the fragments block blood circulation.

Other causes of transient ischemic attack:

Vasculitis (rheumatic, syphilitic, autoimmune);
Hypertension (increased blood pressure);
Diabetes;
Diseases of the coagulation system;
Thromboangiitis.

Neurogenic narrowing of the vascular endothelium occurs due to irritation of the wall by particles of atherosclerotic plaque, blood clots. The pathology of the blood supply is accompanied by swelling of the surrounding tissues, which increases the degree of compression of the cerebral artery.

A transient clinic is formed by platelet emboli. The loose structure of formations is capable of disintegrating.

Transient seizures can be provoked by vascular insufficiency, when the cerebral arteries cause a weak blood flow. Ingestion of an embolus, a thrombus increases the severity of symptoms. After the elimination of chronic insufficiency, the destruction of blood clots, intracerebral circulation is restored.

Symptoms of a cerebral ischemic attack

The TIA clinic depends on the location of the damaged cerebral vessel.

Manifestations of obstruction of the vertebrobasilar artery:

Excessive sweating;
tinnitus;
Dizziness;
Disorders of coordination;
Local amnesia (memory loss);
Visual disturbances - doubling of objects, loss of areas of the visual image, light flashes;
Occipital pains.

A common manifestation of vertebrobasilar syndrome is a short-term loss of consciousness, a positive Romberg test (the inability to touch the tip of the nose with a finger).

Clinic of hemispheric carotid artery syndrome

Specific signs of nosology (ICD code "G45.1"):

Speech disorders;
Partial or complete lack of vision;
Loss of tactile sensitivity of the limbs;
Decreased facial muscle tone;
Convulsive contractions of arms and legs.

A qualified neurologist will be able to determine the area of \u200b\u200bbrain damage by symptoms.

What is thrombosis of the cerebral arteries

Symptoms of circulatory disorders in the cerebral arteries:

Violation of the motor activity of the limbs on both sides;
Convulsive seizures;
Motor and sensory disorders on the opposite side;
Severe speech disorders.

Radiation diagnostics CT and MRI with contrast verifies areas of damaged blood flow in the neck and brain.

How is a TIA different from a stroke?

Persistent occlusion of the cerebral, vertebral, carotid arteries causes a constant lack of oxygen supply to the cerebral parenchyma. Subsequent changes in surrounding tissues cause cell death. Necrosis leads to focal and cerebral symptoms.

Vertebrobasilar insufficiency can be provoked by degenerative changes in the cervical spine, in which posterior bone growths of the semilunar joints are formed, leading to narrowing of the vertebral artery.

The clinic of insufficiency of the carotid arteries appears before a transient attack and is characterized by weak syncope, which increase in the course of the progression of osteochondrosis, spondylosis, and uncovertebral arthrosis.

In terms of prevalence, vertebrobasilar insufficiency is more common than carotid artery embolism.

With ischemic stroke, pronounced disturbances in the blood supply to the brain develop, formed by internal occlusion or external compression of a large artery. Symptoms persist for a long time and can be fatal.

Some doctors call transient cerebral ischemic attacks a microstroke, since about half of the patients with nosology develop an ischemic stroke within a year.

Scientists consider TIA to be a preliminary compensatory mechanism before subsequent acute ischemic brain changes. The appearance of a transient attack contributes to the formation of collateral blood flow to prevent hypoxia.

The first signs of a transient cerebral attack

After the onset of the first manifestations, a thorough diagnosis of the human condition is required. The occurrence of any of the described principles is an indication for going to the doctor:

Foci of discirculatory encephalopathy;
Short-term disturbances of consciousness;
The appearance of a "veil" before the eyes;
Blindness in one eye;
hemianesthesia;
Hemiparesis;
Sensitivity disorders;
Noise in ears;
pallor of the face;
Blueness of the skin;
occipital pain;
Vegetative-vascular reactions;
Dynamic ataxia;
Nystagmus.

Acute violation of intracerebral circulation (stroke) can be prevented if prophylaxis is started in a timely manner.

Recovery after a transient attack

In most people, after a TIA, almost all body functions are restored. The condition is due to compensation for the lack of microcirculation by additional body systems:

Increased heart rate;
Inclusion of additional shunts due to collateral vessels;
Acceleration of metabolic reactions.

The apparent improvement in well-being is temporary. Without prevention and proper rehabilitation, a stroke will appear some time after an ischemic transient attack.

The main task is to find out the causes of an attack with the subsequent correction of pathologies:

Anticholesterol diet;
Normalization of violations of the coagulation system;
Correction of glucose metabolism;
Symptomatic treatment of disorders.

The syndrome of the vertebrobasilar arterial system is characterized by short-term attacks, but recovery from the pathology is impossible. Most forms of circulatory disorders VBB progresses slowly, as they are caused by damage to the cervical spine.

Diagnosis of TIA

After the occurrence of any symptom, a person should be hospitalized in a neurological department. Specialists from European clinics are able to urgently perform an MRI of the head and CT to monitor changes in the brain, diagnose ischemia or differentiate nosological forms.

Visualization of damage to the vessels of the brain allows MR or CT angiography - procedures for contrast examination of the arteries after the introduction of contrast into the vein. Simultaneously with the assessment of the patency of the arterial network, the state of the cardiovascular system is assessed:

Holter monitoring;
echocardiography;
Electrocardiography.

Laboratory diagnostic methods:

Determination of anticardiolipin antibodies, lupus anticoagulant, antithrombin III, protein S and C, D-dimer, von Willebrand factor;
Study of the coagulogram;
Biochemical analysis.

After the appearance of the first neurological signs of a cerebral ischemic attack, consultation of several specialists is required - an oculist, a cardiologist, a therapist.

Transient ischemic attack is an acute transient syndrome associated with local hypoxia and blockage of blood circulation in a certain section of the cerebral cortex. The syndrome occurs suddenly, without prerequisites, and lasts an average of two minutes to half an hour. In everyday life, such a disorder is commonly called a microstroke.

Description and medical history

Severe symptoms associated with a transient ischemic attack (TIA) may last up to 24 hours. Further progress of the attack clinic is usually referred to as a stroke.

Unfortunately, about 60% of all violations are not detected in a timely manner.

This happens in accordance with the non-specificity of its signs, as a result of which the patient does not take them with due seriousness and does not take measures to implement hospitalization.

Moreover, the disorder can occur in a dream, when the patient is deprived of the ability to feel some changes in the body, and since the syndrome does not entail visible consequences, the patient may not even be aware of the attack.

Scientists have noted that about 35% of all people after 50 years old experience a transient ischemic attack.

The cause of a transient ischemic attack lies in a sharp limitation of the blood supply to a fragment of the brain. The pathological process is localized in a separate vascular pool of its cortex.

An extensive vessel that supplies oxygen and blood to the brain is instantly stopped by an atherosclerotic plaque or thrombus localized in nearby arteries. The syndrome can be triggered by an instantaneous hemorrhage, but in this case, the circulation rapidly returns to normal.

In the ICD-10, acute global amnesia belongs to the section of transient ischemic attacks, but some researchers refute this fact, calling the syndrome a variation of the migraine state.

Attacks in ICD-10 are classified as follows:

Transient acute cerebral attacks;
Transient vertebrobasilar insufficiency;
Hemispheric stenosis of the carotid artery;
Extensive syndromes of cerebral vessels;
Fragmented vision dysfunctions;
Acute episodic memory impairment;
Other cerebral ischemic attacks and associated pathological syndromes;
Acute cerebral.

Clinic of the disease

The primary symptoms of an attack may be characterized by a single symptom, or a combination of them. Often they are short-term and weakly intense, which is why the patient does not show proper anxiety and does not go to the doctor. This gives impetus to the evolution of a critical condition and its transition to a stroke.

Traditional symptoms:

Loss of sensation and muscle tone;
myalgia;
Sharp transient blindness or double vision;
General weakness, strong;
Loss of sensation in one part of the body or limb;
Pathological sensations in muscle tissue;
Paresis of one arm or leg;
Partial disorder of auditory function;
Dysfunctions of the speech apparatus;
Inhibition in the selection of words and difficulty in their pronunciation;
Reduced ability to identify body parts;
Uncharacteristic physical activity;
Transient urinary incontinence;
syncope;
Violation of vestibular function;
Falls.

Classification of transient ischemic attacks

Seizure types are classified according to the location of the blocked vessel. One or another part of the brain is responsible for independent functions, and when blood flow to them stops, this factor causes fundamentally different seizures.

Transient ischemic attack in the vertebrobasilar basin

It is noted in 70% of all patients, respectively, is considered a common form of transient ischemic attacks.

The type of disorder is expressed as a combination of the following symptoms and signs:

Recurrent dizziness with autonomic reactions;
Acute pain localized in the occipital region of the head;
High-frequency oscillatory movements of the eyeball;
Sharp double vision;
Bilateral short-term blindness in a limited part of the visual field;
Elementary visual hallucinations (the appearance of extraneous fragments in the field of view: spots, zigzags, pointless figures);
Alternating syndromes (paralysis);
Fainting states;
Disorientation attack and short-term amnesia.

Transient ischemic cerebral attack

This type of attack in the vast majority of cases is detected in newborns and infants.

It is characterized by the following features:

Permanent crying and sleep disturbances;
Decreased natural reflex functions;
Global dysfunction of muscle tone;
Asymmetry of the mimic muscles of the face;
convulsions;
Loss of consciousness.

Transient ischemic attack in the carotid pool

It is characterized by a sharp blockage of the carotid artery. The symptomatology of this type of seizures is considered the most specific and pronounced.

It has the following manifestations:

Transient paralysis of the spinal cord and peripheral central nervous system (mono- and hemiparesis);
Weakening of the threshold of sensitivity;
Speech dysfunctions;
Decreased vision and unilateral blindness.

How eye damage occurs with optic neuritis, you will find in the photo at the link.

Reasons for the development of seizures

The etiological motives that can provoke a transient ischemic attack are diverse: they can be both external and internal.

Most often, attacks of this kind occur in people who have undergone certain syndromes and chronic diseases.

Transient ischemic attacks are noted due to the following common causes:

Transferred profuse blood loss;
Insulin-dependent diabetes mellitus of the second type;
High concentration of cholesterol in the blood;
Severe forms of obesity;
Alcohol abuse and long smoking history;
Passive lifestyle;
Arterial hypertension;
The presence of an artificial heart valve;
Dysfunctions of blood coagulation;
Tachycardia and arrhythmia;
myocardial infarction;
Chronic hypertension;
Excess red blood cells in the blood;
Atherosclerosis.

Differential Diagnosis

An accurate diagnosis is confirmed after a series of studies of the patient's condition. For an adequate assessment of an attack, it may be necessary to consult several doctors, including an ophthalmologist, a cardiologist, and an angiologist.

In some cases, face-to-face testing with a clinical psychologist may be necessary.

Diagnosis of the disease takes place in several stages:

General clinical blood test with the determination of ESR (erythrocyte sedimentation rate);
Doppler study of blood flow;
Biochemical blood test with subsequent assessment of cholesterol and glucose in the blood;
Coagulogram (blood clotting test);
Electrocardiogram;
Vascular ultrasound;
Assessment of the anamnesis and etiology of the disorder;
Family history study;
Somatic and neurological examination;
Cerebral angiography.

Treatment

Therapeutic measures in establishing the diagnosis of "Transient Ischemic Attack" are usually aimed at preventing stroke. After finding out the main factor in the development of seizures, the doctor prescribes to the patient a specific treatment that is directly related to the underlying disease.

Gentle therapy

Electrophoresis with substances aimed at improving metabolism and correcting the work of blood vessels, as well as having a sedative effect;
microwave therapy;
Acupressure;
Physiotherapy;
Circular shower;
Balneotherapy;
Darsonvalization;
Therapy with magnetic fields.

Medical treatment

Antiplatelet agents (aspirin, heparin, warfarin, dabigatran);
Vasodilator drugs (cinnarizine, nicergoline, ticlopedin);
Antihypertensive drugs (guanfacine, clonidine);
Cholesterol level correctors (Nicolar, Lopid).

Operational interventions

They are mainly used for recurrent attacks. The operation consists in excision of the fatty plug that compresses the artery, as well as the elimination of the affected area of the blood vessel. Angioplasty is followed.

Folk methods

The most popular folk remedies in the treatment of transient ischemic attacks are:

Biologically active additives;
Phytotherapy;
Fish fat;
Iodized foods and seaweed;
Melilot officinalis;
Alcoholic infusion of nutmeg.

It is advisable to use folk remedies in the treatment of transient ischemic attack only if adequate treatment has been completed.

Forecast and consequences

A favorable prognosis is guaranteed only if symptoms are detected in time, followed by immediate medical attention and hospitalization. Treatment of the disease is carried out in stationary conditions.

The patient can be allowed to go home only if immediate hospitalization is possible with the resumption of symptoms and their further progression. If symptoms and therapy are ignored, seizures can become chronic.

Approximately one third of all patients who have had a transient ischemic attack experience a stroke. After successful therapy of transient ischemic attack, the patient should be engaged in the correction of some aspects of the lifestyle in order to exclude recurrence and complications.

Preventive measures

For a healthy person, no special recommendations for the prevention of the disease are required.

It is only necessary to eliminate bad habits, if any, be attentive to your own health, weight and nutrition.

If the patient has experienced an ischemic attack before, he needs to carry out maintenance therapy aimed at eliminating the causes that provoke repeated attacks.

So, effective prevention can be in compliance with the following recommendations:

Taking drugs that thin the blood (aspirin, dipyridamole, cyclide, phenylin, heparin);
Proper healthy nutrition;
Refusal of bad habits and products;
Taking antiarrhythmic drugs;
Blood pressure control.

Transient ischemic attack is a serious deviation that can lead to irreversible consequences. Approximately 10% of patients have a stroke 24 hours after the attack.

It affects 20% of patients within a few months. Many people die from myocardial infarction provoked by transient ischemic attacks.

About 30% of all patients suffer from recurrent seizures, as a result of which they acquire cerebral, the severity of which is directly related to their number and intensity.

At the slightest suspicion of a transient ischemic attack, immediate measures should be taken for hospitalization and adequate treatment should be started.