Transient Ischemic Attack (Tia)

A transient ischemic attack is a focal ischemia in the brain, which causes sudden transitory neurological deficits and not from a permanent stroke (z. B. negative results in the diffusion-weighted MRI) is accompanied. The diagnosis is made clinically. Carotid endarterectomy, or stenting, antiplatelet therapy and anticoagulation reduce the risk of stroke by certain types of TIA.

A TIA resembles an ischemic stroke, but the symptoms usually hold <1 h at; most TIA take <5 min. A heart attack is very unlikely if regress deficits within 1 h. As shown by diffusion-weighted MRI and other studies are deficits that are spontaneously resolved within 1 to 24 hours, often accompanied by infarction and are therefore no longer regarded as TIAs. A TIA occurs in patients in middle and old age the most. The occurrence of TIA significantly increases the risk of stroke in the first 24 h after a TIA.

A transient ischemic attack is a focal ischemia in the brain, which causes sudden transitory neurological deficits and not from a permanent stroke (z. B. negative results in the diffusion-weighted MRI) is accompanied. The diagnosis is made clinically. Carotid endarterectomy, or stenting, antiplatelet therapy and anticoagulation reduce the risk of stroke by certain types of TIA. A TIA resembles an ischemic stroke, but the symptoms usually hold <1 h at; most TIA take <5 min. A heart attack is very unlikely if regress deficits within 1 h. As shown by diffusion-weighted MRI and other studies are deficits that are spontaneously resolved within 1 to 24 hours, often accompanied by infarction and are therefore no longer regarded as TIAs. A TIA occurs in patients in middle and old age the most. The occurrence of TIA significantly increases the risk of stroke in the first 24 h after a TIA. Etiology The risk factors for TIA are the same as for ischemic stroke. To the immutable risk factors include alcohol consumption hypertension cigarette smoking dyslipidemia diabetes obesity lack of physical activity high-risk diet (. Eg high in saturated fats, trans fats, and calories) Psychosocial stress (. Eg depression) heart disease (especially diseases predispose to embolisms, such as acute myocardial infarction, infective endocarditis, and atrial fibrillation) drug use (eg cocaine, amphetamines) hypercoagulable vasculitis include the immutable risk factors. previous stroke Seniority stroke family history Male sex most TIA are emboli, mostly from the Carotid or vertebral arteries the causes, although most causes of ischemic stroke (ischemic stroke: Etiology) may also result in a TIA. Unusual causes of TIA are a restricted blood flow by severe hypoxemia, reduced O2 capacity of the blood (eg. As by severe anemia, carbon monoxide poisoning) or increased blood viscosity (z. B. heavy polycythemia), preferably in cerebral arteries with pre-existing stenosis. Systemic hypotension is not usually leads to cerebral ischemia - unless it is heavy, or there is a pre-existing arterial stenosis - because the brain blood flow is maintained over a wide systemic blood pressure range to nearly normal levels by autoregulation. When subclavian steal syndrome withdraws a subclavian artery, which is proximal to the origin of the vertebral artery stenosis, vertebral artery blood (whereby in the vertebral artery blood flow reverses) in order to supply the arm during exercise; characterized mark vertebrobasilar ischemia caused. Occasionally TIA occur in children with severe cardiovascular disease, produce emboli or a very high hematocrit. Symptoms and complaints The neurological deficits similar to those in insults see Table: Selected Stroke Syndrome). A transient monocular blindness (amaurosis fugax), which usually lasts <5 min, may occur if the ophthalmic artery is affected. Symptoms begin suddenly, usually last 2-30 minutes and then recede completely. Patients may suffer in the course of several TIA per day or distributed only 2 or 3 many years. The symptoms are usually similar in consecutive TIA from the carotid artery, but with successive vertebrobasilar attacks they may vary slightly. Diagnosis decline of stroke-like symptoms within 1 hour Neuroimaging A clarification of the cause, the diagnosis is made retrospectively when sudden neurological deficit attributable to ischemia in an arterial supply area, located within 1 h regress again. An isolated peripheral facial paralysis, loss of consciousness or level of consciousness can not think of a TIA. TIA must be distinguished from other causes of similar symptoms (eg. As hypoglycemia, migraine aura, ictal [TODD] palsy). Because a heart attack, a small circulation and even a space-occupying lesion can not be ruled out clinical, imaging is required. Normally, a CT is most immediately available. However, the CT infarctions to> 24 h can not always identify. (Editor’s note: The CT diagnostics is less sensitive than MRI diagnostics in the acute phase.) The MRI typically covers an evolving infarction within hours. Diffusion-weighted MRI is the most accurate imaging method to rule out a heart attack in patients with suspected TIA, but it is not always available. The search for causes of a TIA is similar to ischemic stroke at one. The investigation includes testing for carotid stenosis, cardiac embolic sources, atrial fibrillation, the search for hematological abnormalities and screening for risk factors for stroke. Because the risk of subsequent ischemic stroke is high and immediate, the referral should be rapid, usually on admission. It is not clear which patients, if any, can be released from the emergency room safe. The risk of stroke after TIA or minor stroke is highest h in the first 24 to 48, so that, even if only a presumption exists, patients referred generally to the hospital for telemetry and evaluation. Therapy stroke prevention Treatment is directed at the prevention of insults; Antiplatelet agents and statins are used (acute treatment). A Karotisthrombendarteriektomie or arterial angioplasty plus stenting may be useful for some patients, especially for patients without neurological deficit, but with a high Insultrisiko. Anticoagulation is indicated if cardiac embolic sources are present. The change of stroke-related risk factors can prevent strokes if possible. Key points A focal neurological deficit, which dissolves within 1 h, is almost always a TIA. Investigation as an ischemic stroke. Use the same treatments (eg. As platelet aggregation inhibitors, statins, sometimes carotid endarterectomy or arterial angioplasty and stenting) and for the secondary prevention of ischemic stroke.

Health Life Media Team

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