Tranzitorny ischemic attack

Description:

The Tranzitorny Ischemic Attack (TIA) — a kind of the passing disturbance of cerebral circulation (PDCC); sharply arising disturbance of a cerebral hemodynamics which is shown first of all the focal neurologic symptomatology depending on localization of defeat in this or that vascular pool.

The disturbances caused by typical TIA last up to 1 days. Lasting deviations more than 24 watch the attack is classified as a stroke.

TIA are most typical for patients with atherosclerotic occlusion of the main arteries of the head: in system of carotid arteries (the place of bifurcation, an internal carotid artery) and vertebralny arteries (in combination with a compression and a vasomotor spasm owing to osteochondrosis).

Symptoms of the Tranzitorny ischemic attack:

The clinical picture of the tranzitorny ischemic attacks is characterized by passing focal neurologic symptoms and depends on the pool of disturbance of blood circulation of a brain (carotid or vertebro-basilar). In most cases the diagnosis of TIA is made retrospectively as at the time of survey of the patient with the specialist the focal neurologic symptomatology at it is absent. In this regard careful collecting the anamnesis and knowledge of clinical manifestations of TIA are necessary.

TIA in the pool of carotid arteries are shown passing mono - or a hemiparesis, sensitive disturbances, alalias. The passing vision disorder on one eye on the party of the struck internal carotid artery is sometimes observed. Patients can complain of "the shadow falling before an eye" or by "a white veil".

TIA in the vertebro-basilar pool are most often shown by passing vestibular and cerebellar frustration (a rotatory vertigo, nausea, an ataxy), indistinctness of the speech (dysarthtia), numbness on a face, a diplopia, unilateral or bilateral motive and sensitive frustration. The hemianopsia or a passing vision disorder on both eyes is sometimes observed.

The isolated dizziness, nausea or vomiting are not characteristic of TIA, they most often are followed by other trunk symptoms. Many researchers consider a number of the symptoms which were earlier attributed to TIA in the vertebro-basilar pool (syncopal states, epileptic seizures) unusual for this pathology.

The passing blindness (the tranzitorny monocular blindness (TMB), or amaurosis fugax) — a state is more often unilateral suddenly arising short-term (usually within several seconds) than loss of sight owing to passing ischemia in the field of blood supply orbital, back tsiliarny arteries or an artery of a retina. The vision disorder is more often described by the patient as "curtain" or "gate" which approached from top to down or from below up. Sometimes loss of sight is limited to an upper or lower half of a field of vision. Usually TMS arises spontaneously, without provocative factors, however can be sometimes caused by bright light, change of position of a body, physical exercises or a hot bathroom. Pain is not characteristic of TMS. The monocular blindness can be not the only complaint. Also other symptoms are observed: a contralateral hemiparesis and a gemigipesteziya to the corresponding hemisphere at severe defeat of a carotid artery. TMS can repeat (usually in the same way), but the area of a vision disorder varies depending on an ischemia zone.

The Tranzitorny Global Amnesia (TGA) — a unique syndrome at which the patient, is more often than middle age suddenly loses a short-term memory at relative safety of memory on the remote events. Consciousness of the patient  and orientation in own personality are not broken, but incomplete orientation in space and a surrounding situation, repetition of stereotypic questions, confusion takes place. The etiology of this drama syndrome remains to the unknown, it try to explain with ischemia hippocampal форникальной systems. Some authors consider this pathology an epileptic phenomenon or option of migraine. Episodes of TGA are often started by certain factors, such as emotional experiences, pain, sexual intercourse. Attacks usually last of several tens minutes till several o'clock. Memory recovery full. Neurologic deficit at the same time does not happen. Tendency to repetition small, frequency rare — 1 time in several years. Such patients have risk factors of development of cerebrovascular pathology, especially arterial hypertension.

Hypertensive cerebral crises arise against the background of increase in arterial pressure more than 180 — 200 mm of mercury. (systolic) when the autoregulyation of cerebral circulation at its upper bound breaks. It leads to passive stretching of vessels of a brain and increase in amount of the blood coming to vessels of a microcirculator bed with the increased intravascular pressure. Such processes cause filtrational (vazogenny) hypostasis, increase in volume of a brain and ischemia of tissue of brain owing to a prelum of vessels of the microcirculator bed having usually "spotty" character. All these changes are especially expressed in zones of adjacent blood circulation in the field of occipital shares as here an arterio-arterial anastomosis is rectilinear. Occipital pains and visual disturbances (photopsias) characteristic of cerebral vascular crises are connected with it. From other focal symptoms numbness, a pricking, decrease in painful sensitivity in the field of a brush, language, extremities, meningeal symptoms are observed. Into the forefront all-brain symptoms act: diffusion headaches which have the pressing or arching character and often are followed by nausea and vomiting, feeling of noise in the head, dizziness of preferential not system character. Other clinical displays of hypertensive cerebral crisis depend on its type: heart, hyperkinetic of which increase in minute volume of heart is characteristic; eukinetichesky with normal minute volume, and the increased vascular resistance; heart, hypokinetic with a reduced minute volume, and sharply increased vascular resistance.

Reasons of the Tranzitorny ischemic attack:

The factors promoting development of tranzitorny ischemia:
- Myocardial infarction, disturbances of a cordial rhythm, blood loss.
- Pathology of the valve device of heart of various etiology, especially at a rheumatic carditis aggravation, an acute infectious endocarditis, etc.
- Increase of expressiveness of disturbance of rheological and coagulative properties of blood.
- Distsirkulyatorny encephalopathy of II and III stages, quickly progressing course of atherosclerosis.
- Occlusion of an ekstratserebralny vessel more than 50% of diameter, emergence of a stenosis in the main arteries of other pool.

Treatment of the Tranzitorny ischemic attack:

In a hospital will conduct an extensive range of examinations: integrated clinical and biochemical analysis of blood, EEG, KT, MRT, ultrasonic doppler sonography. Sometimes appoint an angiography, an ECG. Treatment is carried out in the conditions of a hospital if from the moment of an attack of TIA there passed no more than 2 days, and also at repeated TIA, cardiovascular diseases, including atherosclerosis. Patients are subject to obligatory hospitalization 45 years and those who had similar complaints in the last 5 years without age are more senior.

Out-patient treatment is possible only if the patient has a possibility of immediate hospitalization in couples repeated TIA. The confirmed TIA demands the treatment directed to the prevention of the repeated attacks, a stroke, myocardial infarction. It is reached by purpose of antiagregant, anticoagulants, the drugs normalizing a tone of vessels.