Angina

What is a transient attack? Transient ischemic attack: causes, signs, diagnosis, therapy, prognosis

Ischemic attacks are acute and short-term disturbances in the blood circulation of the brain, the peculiarity of which is that they all have a reverse reaction within 24 hours after their onset. The symptoms of an ischemic attack of the brain are very similar to an ischemic stroke, but the difference is that it lasts a short time. After the attack is over, all brain functions are restored. Minor damage occurs in brain tissue that does not affect a person’s functional capabilities.

Reasons and factors

The main factors that cause ischemic attacks are microemboli. They are caused by a number of reasons:

Development of atherosclerosis

actively developing atherosclerosis of the brain, as a result of which narrowing of large vessels occurs, cholesterol deposits are formed on the walls, which sometimes disintegrate and are carried into small vessels by the blood flow, causing thrombosis, as a result of which tissue necrosis develops;
thromboembolism, which develops as a result of various heart diseases;
surges in blood pressure;
disruption of the normal rhythm of the heart muscle;
by squeezing the arteries that supply blood to the brain (during operations on the carotid artery, with very sharp turns of the head, etc.);
blood thickening due to various factors;
problems of the cervical spine, which leads to deterioration in functionality as a result of impaired blood flow in the arteries supplying the brain;
severe and prolonged headache.

Ischemia can also occur as a result of diabetes mellitus, systematic smoking and alcohol consumption, cholesterolemia and physical inactivity.

Forms of pathology

Depending on the location where the blood flow was disrupted, various forms of ischemic attacks are distinguished:

in the vertebrobasilar region - in the basilar or posterior cerebral artery;
in the carotid region - in the anterior or middle cerebral artery.

Depending on the side of the head where the blood flow was disrupted, right-sided and left-sided ischemic attacks are distinguished.

Symptoms and signs

An ischemic attack, the symptoms of which are similar to those of other diseases, causes panic in the victim. He cannot understand what happened to him. Symptoms of an attack vary depending on the area in which the disruption of blood flow to the brain occurs. These areas are called vascular territories. There are two main vascular regions - vertebrobasilar and carotid (or the area of the carotid arteries).

Impaired blood flow in the vertebrobasilar region of the brain is characterized by the following symptoms:

dizziness;
gag reflex and attacks of nausea;
speech dysfunction;
minor spasms of the facial muscles causing facial hardening;
short-term visual impairment (fogginess and darkening of the eyes, inability to focus);
decreased sensitivity of the skin;
motor dysfunction;
loss of orientation in time and space;
panic attacks;
short-term memory lapses, which are expressed by the inability to remember your name, age, place of residence.

If there is a circulatory disorder in the carotid region of the brain, the patient will experience the following symptoms:

deterioration of skin sensitivity;
violation of speech function (it becomes incoherent and incomprehensible);
numbness and loss of mobility of the upper and lower extremities, sometimes numbness occurs on one side of the body;
apathy;
drowsiness;
panic attacks.

Sometimes with both types of ischemic attack there is a severe headache. The patient panics, declaring that his head will explode from the pain.

An ischemic attack passes in a few minutes, but you should not relax, because it can recur soon and cause various consequences: in 15% of patients after the first attack of an ischemic attack in the first three months, and in 25% within a year, an ischemic stroke occurs. In 20% of patients who have had an ischemic attack, it does not recur for several years or never.

Symptoms of an attack disappear within 10-15 minutes, so it is recommended to remember most of the symptoms before the ambulance arrives or the victim is transported to the hospital independently. This will help the doctor make the correct diagnosis.

Diagnostic methods

Diagnosis begins with a survey that will help create a picture of the disease. The doctor is trying to figure out the following points:

when symptoms first appeared (vision problems, impaired motor function and sensitivity, etc.);
how long has passed since the first attack, and how long it lasted;
whether such attacks have occurred in relatives;
an attack or health complaints appeared at rest or after significant physical exertion;
whether the patient has previously had cardiovascular diseases, thrombosis, or atherosclerosis of cerebral vessels;
does the patient have bad habits;
what kind of life he leads.

Next, the doctor performs a neurological examination, during which he tries to detect signs of neurological disorders (vision problems, loss of skin sensitivity, slight paralysis, etc.).

To detect blood thickening, a general analysis is prescribed.

For a more detailed study of the human body, special diagnostic devices are used:

MRI

Magnetic resonance imaging of the neck and head - studies the structure of the brain. This study is necessary to rule out ischemic stroke. After an attack of ischemic attack, the procedure fails to detect significant damage to the arteries and brain tissue. To do this, a search is made for dead areas of the brain and the patency of the arteries is assessed.
Electrocardiography is an analysis of the heart rhythm to identify its abnormalities.
Ultrasound examination of large vessels of the brain - the patency of the cervical arteries is analyzed.
Echocardiography - searches for blood clots in the cavities of the heart muscle.
Dopplerography of cerebral vessels evaluates the amount and speed of blood passing through.

If there are suspicions of concomitant diseases that could cause an ischemic attack, additional examinations and consultations with specialized specialists may be prescribed.

Diagnosing an ischemic attack is very difficult because its symptoms resemble those of other diseases. For example, Meniere's disease and diabetes mellitus can cause ischemic attacks, and epilepsy and migraine have very similar symptoms. Therefore, the main task of diagnosis is not only to confirm the diagnosis, but also to identify the causes of the disease. For this purpose, a complete examination of the body is often prescribed.

The ischemic attack itself is not as terrible as the consequences it can cause.

Treatment options

Most experts believe that an ischemic attack does not require treatment, because after just a day there are practically no signs of it. However, if an ischemic attack occurs, treatment should be aimed at identifying and suppressing the cause of its occurrence. Lack of medical intervention will sooner or later lead to an ischemic stroke.

After an attack, the patient is hospitalized for observation and examination. The causes of ischemic attack are treated with medications.

If cholesterol levels are high, statins are prescribed to dissolve cholesterol crystals.

With increased tone of the sympathetic nervous system, tinctures of ginseng, zamanika and caffeine, high doses of vitamin C and calcium supplements are prescribed.

With increased tone of the parasympathetic nervous system, herbal tablets based on belladonna, antihistamines and a high dose of vitamin B6 are prescribed. To treat the symptom of persistent weakness, potassium supplements and small doses of insulin are prescribed.

To improve the condition of the autonomic nervous system, medications Ergotamine and Hydraxin are prescribed.

To treat high blood pressure, long-term use of beta-blockers, ACEs and calcium antagonists is prescribed. However, the main drugs are drugs that improve venous blood flow and metabolism in brain tissue.

If the normal fluid state of the blood is disrupted, anticoagulants and antiplatelet agents are prescribed.

To prevent ischemic attacks, drugs to improve memory (Piracetam, Actovegin and Glycine) are used.

Antioxidants and vitamin complexes are prescribed for the treatment of neurotic and depressive conditions.

Ischemic attack in pregnant women and children

Attacks of ischemic attacks in pregnant women are quite common. After such attacks, women are placed under observation in a hospital. A complete examination of the cardiovascular system of mother and child is carried out. In most cases, treatment is not carried out before birth. The woman is under close supervision, because there is a possibility of developing an ischemic stroke.

In very rare cases, ischemic attacks occur in children. This diagnosis is dangerous because it causes consequences such as paralysis, slurred speech and mental impairment. The younger the child, the more the symptoms worsen. The child must be hospitalized. Drug treatment and special physical training are carried out to facilitate the rapid restoration of the child’s body functions.

Folk remedies and ischemic attacks

Herbal mood

After the first attack of an ischemic attack, it is recommended to use herbal infusions to strengthen cerebral circulation and prevent new attacks.

Herbal infusion recipe No. 1. To prepare it, you need to take 2 parts each of dark brown nonea and borage flowers, 1 part each of thyme, dried cucumber, motherwort, mint and dill seeds. All components are thoroughly mixed and poured with two glasses of hot water. The mixture is infused in a warm place for 2 hours. The herbal infusion is filtered and consumed 100 ml 3 times a day half an hour before meals.

Recipe for herbal infusion No. 2. You need to take 1 part each of dry nonea, forest chickweed, lemon catnip, hop cones and 2 parts birch leaves. All herbs are ground in a coffee grinder. 1 tsp The mixture is poured with 1 glass of hot water and left for 2 hours. The herbal infusion is filtered and consumed 2 tbsp. l. 3 times a day before meals.

Herbal infusions are taken in courses lasting 3 weeks. While taking them, blood pressure is constantly measured.

Preventive measures

In order to reduce the possibility of developing an ischemic attack, it is recommended to adhere to the following rules:

Proper and nutritious nutrition.
Exercise (at least thirty minutes of morning exercise).
Support of normal body weight.
Periodic diagnosis of the cardiovascular system and timely treatment of diseases: elimination of heart rhythm disturbances, periodic monitoring of blood pressure levels.
Annual cholesterol monitoring.
Annual diagnosis of the condition of the vessels that supply blood to the brain. If there are problems, timely treatment is recommended, including surgical correction of the narrowing of the lumen of the arteries.

During pregnancy, a woman must register before 12 weeks. During the entire period of pregnancy, a woman should visit an obstetrician-gynecologist in a timely manner.

Quitting smoking and alcoholic beverages is also important in the prevention of pathology. After the first attack of ischemic attack, alcohol consumption in any form is prohibited for 6 months.

Video

A transient ischemic attack is a transient episode of central nervous system dysfunction that is caused by a disruption of the blood supply to certain areas of the brain/spinal cord or retina without signs of acute. Most often, transient ischemic attack is diagnosed in elderly people.

The condition in question increases the risk of developing ischemic stroke - for example, 10% of patients develop a stroke in the first 2 days after a transient ischemic attack, another 10% of patients develop a stroke three months after the attack, and 20% develop a stroke within a year. That is why the condition in question is defined by doctors as urgent, requiring emergency medical care. Moreover, the sooner this assistance is provided, the greater the chances for a complete recovery and a normal quality of life for the patient in the future.

Reasons for the development of transient ischemic attack

Transient ischemic attack is not an independent disease, since its occurrence is facilitated by pathologies of the blood vessels and blood coagulation system, disruption of the heart and other organs/systems. Doctors identify several pathological conditions, against the background of which the condition in question most often develops:

cerebral vessels;
coarctation of the aorta;
systemic vascular diseases;
ciliated;
hypoplasia of cerebral vessels;
dilated cardiomyopathy;
pathological tortuosity of cerebral vessels;
antiphospholipid syndrome.

In addition, risk factors for transient ischemic attack include:

installed heart valves;

Please note:The risk of developing the condition in question is higher, the more provoking factors one particular person has. For example, a patient is diagnosed with diabetes mellitus, leads a sedentary lifestyle and smokes - the risk of transient ischemic attack almost doubles.

The mechanism of development of the phenomenon under consideration is a reversible decrease in blood supply to a particular area of the central nervous system or the retina. That is, a blood clot forms in a certain area of the vessel, which obstructs blood flow. Due to a lack of blood in the distal parts of the brain, an acute lack of oxygen occurs, and their functions begin to be impaired.

Please note:during a transient ischemic attack, the flow of blood to the brain tissue does not completely stop, but is simply limited. If blood stops flowing to the brain tissue, a cerebral infarction or ischemic stroke will develop.

The condition under consideration has an important difference - it refers to a reversible process: after 1-3-5 hours or several days, blood flow in the ischemic area is restored, and the symptoms of the disease regress (disappear).

Classification of transient ischemic attack

The classification of the condition under consideration directly depends on the location of the thrombus. If you follow the international classification of diseases, a transient ischemic attack may be one of the following options:

carotid artery syndrome;
unspecified transient ischemic attack;
vertebrobasilar system syndrome;
bilateral multiple cerebral artery symptoms;
transient global amnesia;
transient blindness.

Symptoms of transient ischemic attack

The clinical manifestations of the condition in question are quite variable.

With vertebrobasilar artery syndrome, the patient will complain of:

intense;
flashes of light, which refers to visual disturbances;
, and intense hiccups;
with localization in the occipital part of the head;
expressed;
impaired coordination of movements;
fluctuations in blood pressure;
transient amnesia (memory impairment).

Patients in this condition are distinguished by pale skin, they have involuntary oscillatory movements of the eyeballs in the horizontal direction, they are unable to touch the tip of the nose with a finger with their eyes closed (they miss).

Symptoms of carotid artery syndrome:

a sharp decrease or complete absence of vision in one eye, always starting suddenly;
severe weakness, numbness and decreased sensitivity of the limbs on the side opposite to the affected organ of vision;
short-term and unexpressed speech impairment;
short-term cramps in the limbs.

If a transient ischemic attack takes place in the area of the cerebral arteries, it will manifest itself with the following symptoms:

transient speech disorders;
loss of vision on the side of the affected vessel;
impaired movement of the limb on the opposite side of the affected vessel;
sensory disorders.

Pathologies of the cervical spine and the transient ischemic attack that arises against this background cause attacks of sudden muscle weakness - the patient suddenly begins to fall, becomes immobilized, but is fully conscious. Literally within a few minutes the patient’s condition is restored.

Diagnostic measures

If a person develops symptoms characteristic of a transient ischemic attack, he should be immediately sent to a medical facility. Neurologists treat this pathology.. Doctors give him an emergency examination, which will allow them to determine the nature of the pathological changes and conduct a differential diagnosis of the condition in question.

In addition, the patient may undergo additional examination - for example, CT angiography, rheoencephalography. These methods enable the specialist to determine the exact location of the vessel obstruction.

Without fail, a patient with symptoms characteristic of the condition in question is prescribed:

coagulation system study ();

Please note:Doctors must differentiate transient ischemic attack from other diseases with similar symptoms. Such diseases include multiple sclerosis, acute labyrinthitis, epileptic seizures, myasthenic crises, panic attack, and metabolic disorders.

General principles of treatment of transient ischemic attacks

Treatment of the condition in question should be started as early as possible, because this is the guarantee of recovery. The patient is prescribed intensive therapy, which includes:

Please note:It is strictly forbidden for patients with transient ischemic attack to sharply reduce blood pressure; it must be maintained at a slightly elevated level - within 160-180/90-100 mm Hg.

If there are indications, then after a full examination and consultation with a vascular surgeon, the patient may be prescribed surgical intervention - carotid endarterectomy, carotid angioplasty with stenting.

Prevention of transient ischemic attacks

To prevent the development of the condition in question, you must follow the recommendations of specialists:

Carry out adequate therapy for arterial hypertension - for example, the blood pressure level should be maintained at 120-80 mm Hg, antihypertensive drugs should be taken regularly, lifestyle and diet adjustments are required.
Monitor and maintain the level within normal limits. This can be done by normalizing nutrition, maintaining an active lifestyle and taking lipid-lowering drugs.
Give up bad habits - sharply limit, and optimally, completely give up smoking, and drink alcoholic beverages in moderation.
Regularly take medications that can interfere - for example, 100 mg per day. But this can only be done after consultation with specialists - the drugs have certain contraindications.
Timely and fully treat diseases that can lead to the development of transient ischemic attack.

If the patient quickly responds to the development of the condition in question and receives emergency medical care, then his recovery will soon occur and the person will be able to return to a full life. Otherwise, the risk of rapid development of a stroke or cerebral infarction will lead to the death of the patient. Even if the symptoms were short-term and mild, you will need to visit a neurologist in the near future and receive instructions regarding the normalization of your health.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Diseases of the heart and circulatory system are accompanied by significant mortality. The likelihood of death or severe disability varies widely. However, there are no completely safe conditions.

Transient ischemic attack is a transient acute disorder of the nutrition of cerebral structures (abbreviated as TIA). This condition is similar to a stroke in its clinical picture and initial manifestations.

But in contrast to generalized necrosis, the death of individual areas of a small area is observed. That is, a full-fledged neurological deficit does not have time to form. The process regresses spontaneously after a maximum of a day from the beginning.

It is impossible to determine by eye what is happening. Patients with transient ischemic attack are transported to a neurological hospital.

An emergency condition has another name - which does not entirely accurately reflect reality. Treatment is aimed at correcting the condition, relieving symptoms and preventing relapses or worsening the patient’s situation

The pathological process is based on acute cerebral ischemia.

The reasons are various:

Hypertension. A persistent increase in blood pressure against the background of other problems or as a primary condition.
Atherosclerosis. Narrowing or blockage of large vessels by cholesterol plaques. Requires urgent correction. There is time for it, given that the process is chronic, continues and progresses for years.
Vertebro-basilar insufficiency. Malnutrition of the occipital lobe of the brain as a result of osteochondrosis, atherosclerosis, myositis, hernia of the cervical spine. It provokes TIA in the vertebrobasilar region.

Heart defects. Accompanied by a decrease in the pumping function of a muscular organ. They pose a colossal danger to all systems, not just the brain.

The undisputed leader was and remains atherosclerosis. Narrowing or blockage of blood vessels in cerebral structures by cholesterol plaques and, as a result, a decrease in arterial patency.

A drop in blood flow speed leads to disruption of the trophism (nutrition) of nerve clusters. A complete clinical picture develops with severe headache, loss of consciousness, and other symptoms of neurological deficit.

The main difference from a stroke is that the degree of deviation does not reach a certain critical mass when the process affects large volumes of tissue.

As a rule, an ischemic attack goes away on its own, after a few hours, or at most a day. A deficiency does not form, the patient continues to live as before.

However, a transient ischemic attack indicates the likelihood of experiencing a full-blown stroke in the near future. This means that there is a pathology of the cardiovascular system that has simply not been identified or is being treated incorrectly.

Primary or re-diagnosis, prescription or correction of the course of therapy are indicated. The likelihood of an emergency and, possibly, death of a person depends on this.

Symptomatic treatment does not make sense, since the underlying process will sooner or later lead to a full-fledged stroke.

Common symptoms of TIA

Manifestations are divided into generalized, caused by brain damage, and focal.

The latter indicate the nature of the disorder much more clearly, since they depend on the location of tissue necrosis.

Severe headache. Localized in the area of the back of the head and crown. It may be diffuse, so the patient is not always able to indicate the exact location of the unpleasant sensation. The intensity is so great that the person is unable to get out of bed and takes a forced body position. The nature of the discomfort is stabbing, “hitting the head” in time with the contractions of the heart. It is extremely difficult for patients to tolerate.
Pre-fainting state. Against the background of ischemia of cerebral structures. It occurs suddenly and may result in loss of consciousness. However, this is not always the case. Accompanied by darkening of the eyes and tinnitus. The sounds cause a painful reaction, weakness, especially in the legs, pallor and increased sweating. Cold skin.
Nausea, less often vomiting. It is of a reflex nature, therefore it does not bring relief as in case of poisoning. Can be repeated several times until the condition is corrected.
Drowsiness, decreased performance. The person is lethargic, apathetic. Lies in one position. Movement provokes increased headaches.
Less commonly, chest discomfort. This is usually an indication of the cardiac origin of the pathological process. A parallel course of emergency conditions is possible. It is even more impossible to delay calling an ambulance.
Apathy, mental disorders. Neurological deficits do not always occur; at least, it is impossible to determine at first glance; a series of tests is required.

Occipital lobe

Poor nutrition provokes visual manifestations. Against the background of a transient ischemic attack (TIA), simple visual hallucinations occur, such as photopsia (lightning flickering), changes in the shape and size of objects.

In severe cases, complete loss of vision is possible; this is a temporary phenomenon. The so-called cortical transient blindness.

The cerebellum is also located here. When it is involved in the pathological process, dizziness occurs. Loss of orientation in space forces a person to lie down or sit down and move less.

Temporal lobe

Symptoms of an ischemic attack of the brain of this location are associated with the ability to perceive verbal information and analyze it.

A spontaneous loss of selective mnestic functions occurs. Epileptic seizures with severe tonic-clonic convulsions and loss of consciousness are possible.

Additionally, memory lapses of the anterograde amnesia type are detected (the patient does not remember what happened to him from the onset of TIA until the restoration of higher nervous activity).

Less commonly, transient global episodes of memory loss. Lasts up to 24 hours maximum.

Complex hallucinations with bizarre plots are possible. These are psychotic moments, the so-called oneiric clouding of consciousness.

Parietal lobe

Signs of transient ischemic attack:

Loss of ability to manipulate numbers, write and read.
Olfactory hallucinations, tactile false sensations. Paresthesia. The patient feels as if something is moving under his skin, etc. The condition is caused by a violation of innervation, false signals to the endings localized in the upper layers of the dermal integument.
Lack of tactile sensitivity. The patient is unable to recognize objects by touch upon physical contact.

Concentration also decreases.

Frontal lobe

Responsible for a person’s ability to think and creative activity. Behavior control and a number of other functions.

Symptoms of transient ischemic attack of the frontal lobe: paresis, paralysis, including oculomotor nerves, induced temporary dementia, decreased productivity of thinking, flattening of affect, disinhibition: a person becomes overly excited, inadequate.

In addition, we find:

Unsteadiness of gait. Inability to move in a straight line. Falls.
Weakening of basic reflexes. Observed during routine examination.
Loss of smell.

When the brain stem is damaged, cardiac dysfunction is detected, organ arrest and asystole are possible. Also breathing.

Even a transient weakening of blood circulation in this area threatens the patient with rapid death. Urgent hospitalization is indicated.

Diagnostics

Carried out on an emergency basis. If a person is able to think, speak, and basic body functions are normal, there is time for a thorough examination.

Otherwise, the level of blood pressure, heart rate, and respiratory movements are assessed. It is necessary to stabilize the person's condition.

At the end of the initial measures, when the patient has come to his senses and recovered, it is necessary to identify what caused it.

List of events:

Oral questioning of the patient regarding complaints, their duration and nature. Objectification of symptoms allows you to decide on a further diagnostic scheme.
Anamnesis collection. What and when the person was sick with, habits, family history. The main probable diagnosis that provokes TIA is atherosclerosis. Slightly less common is vertebrobasilar insufficiency. Other options are possible.
Assessment of neurological status. Routine techniques are aimed at building hypotheses. Even they are confirmed or refuted in order.
Blood pressure measurement. Typically, the indicator immediately after the end of a transient ischemic attack is slightly below normal. In the presence of diseases of the cardiovascular system, it is higher than the adequate value. Heart rate is also examined. Changes are present only in the presence of pathologies of cardiac structures. A microstroke has nothing to do with it unless the brain stem is affected.
Electrocardiography. Evaluates possible arrhythmias.
Echocardiography. Used to identify heart and vascular defects.
EEG. To determine the degree of damage to cerebral tissue.
Dopplerography, duplex scanning of the brain. To detect blood flow disturbances. Cervical arteries are also subject to diagnosis. Vertebrobasilar insufficiency is possible. It affects mainly the occipital lobe.
Laboratory tests. The key one is a biochemical blood test. The concentration of low- and high-density lipids is studied. The first is the so-called “bad” cholesterol, which is deposited on the walls of blood vessels and provokes atherosclerosis. The second, on the contrary, helps normalize the condition and removes excess fatty substances.

The list can be expanded as necessary. A neurologist in this case is a specialized specialist.

Other doctors are being recruited as part of the expanded study. To identify the origin of ischemia and eliminate it.

Treatment

It is carried out in a hospital. On an outpatient basis, recovery is possible after correcting the condition and identifying the cause. Everything takes no more than a week. The basis of therapy is the use of medications.

What is used:

Antihypertensive. , means of central action, . Only in the presence of a proven stable increase in blood pressure.
Cerebrovascular medications. To improve cerebral blood flow. Actovegin, Piracetam. Courses. It is possible to repeat treatment at the end of the rehabilitation period as part of prevention.
. To increase vascular resistance to negative factors.
. To restore blood fluidity and rheological properties. Heparin, Aspirin as the main ones. Other names are possible, depending on the doctor’s decision and the specific clinical situation. Many drugs are contraindicated in precursors of stroke.
Statins. Dissolve lipid structures, remove cholesterol. Atoris and analogues. Used to treat atherosclerosis.
Analgesics based on metamizole sodium (Pentalgin, as an example).

Physiotherapy upon completion, physical education, massage of the collar area for proven vertebrobasilar insufficiency due to osteochondrosis.

Transient ischemic attacks are acute disturbances of cerebral blood flow. Drug treatment alone will not be enough. Lifelong habit correction required:

Quit smoking, alcohol, and especially psychoactive substances.
It is not recommended to take medications without specialist prescription. Including anti-inflammatory ones. Analgesics.
Minimize the amount of fried and smoked foods. No semi-finished products, it is not advisable to consume canned food. Salt no more than 7 grams per day.
Physical activity is at a minimum level. No overload. Only quiet walks. Physical inactivity is also unacceptable. This is the path to complete necrosis of nerve tissue.
Regular examinations with a neurologist.
Dream. About 7-10 hours per night.
Drinking regime is individual. No more than 1.8 liters. Less in case of impaired renal function.

The indicator is calculated based on the characteristics of physical activity, metabolism, body weight, so the numbers are approximate. It is better to ask the question to your treating specialist.

Forecast

Favorable in most cases. But a transient ischemic attack is a wake-up call. If it occurs, it means there is a malnutrition of the cerebral structures.

It is not yet so critical as to provoke pronounced necrosis of nerve clusters, but it is not far from that.

The outcome depends on many factors: gender ( in men it is a priori somewhat worse), age (young people tolerate ischemic attacks more easily, further risks are also lower), medical history, including family history, lifestyle. The more bad habits, the worse the likely outcome of the disease.

It is better to clarify the question with your attending physician, because no two cases are alike.

If you follow the average calculation, lethal TIA turns out to be extremely rare, and not on its own, but as a result of the transformation of the process into full-fledged tissue necrosis. The probability is no more than 3-5%.

Possible consequences

The main consequence is the transition of a transient ischemic attack to a stroke, the death of brain cells.

The result is the death of the patient or profound disability as a result of persistent neurological deficit in the lesion.

On the other hand, the formation of vascular dementia is possible. This condition resembles classic Alzheimer's disease, but does not have gender and age preferences, and is potentially reversible when the primary cause of the pathological process is eliminated. Therefore, it is initially associated with a better prognosis for complete recovery.

The issue also needs to be considered more broadly. First of all, it is worth determining what caused the TIA.

If we are talking about the heart, it is likely that a heart attack will develop, worsening failure, multiple organ dysfunction, and other dangerous conditions. The same applies to atherosclerosis.

If an aneurysm is to blame, it is likely to rupture and the patient will die from massive bleeding. Therefore, the doctor must pay attention to all factors. A microstroke is usually the least of the problems.

Transient ischemic attack, a precursor to full-fledged necrosis of nerve tissue, develops spontaneously as acute transient ischemia of cerebral structures.

The recovery is comprehensive. At the end of the initial treatment, you need to tackle the provoking factor. Without eliminating it there is no chance of success.

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

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

What is 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) last several hours. Embolism, thrombosis of the anterior and posterior cerebral arteries causes symptoms for up to 24 hours.

Transient cerebral ischemia is a condition that some doctors consider the early stages of a stroke. The only difference is the time period for maintaining the clinic. Both nosological forms require careful diagnosis of the state of the brain within 60 minutes after occurrence, since delay is dangerous for the patient’s life.

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

Percentage risk of cerebral stroke after transient cerebral attack:

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 of development. Timely provision of assistance is an important stage, but it is possible to prevent a stroke after an attack only through 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 Disease, 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 brainstorms – “G45.8”;
Ischemic attack, unspecified - “G45.9”.

The ICD 10 code for transient ischemic attacks is “G45”.

The nosological form of cerebral microcirculation disorder should be determined immediately after the patient’s admission, which will allow choosing therapeutic tactics and methods of prevention.

The symptom of “transient blindness” is accompanied by the appearance of a “flap” in one eye, which occurs suddenly or forms after an irritating factor - a flash of light, exposure to the hot rays of the sun. The pathology can be accompanied by muscle cramps on the side opposite to the source of damage. 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 and performs stereotypical actions.

Causes of ischemic attack

A common cause of transient cerebral ischemia is microemboli formed from a primary atherosclerotic plaque. The formations consist of cholesterol particles and platelet accumulations. Once inside the cerebral arteries, the fragments block blood circulation.

Other causes of transient ischemic attack:

Vasculitis (rheumatic, syphilitic, autoimmune);
Hypertension (high blood pressure);
Diabetes mellitus;
Diseases of the coagulation system;
Thrombangiitis.

Neurogenic narrowing of the vascular endothelium occurs due to irritation of the wall by particles of atherosclerotic plaque and 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 clinical picture is formed by platelet emboli. The loose structure of formations is capable of disintegrating.

Transient attacks can be provoked by vascular insufficiency, when the cerebral arteries cause poor blood flow. Entry of an embolus or thrombus into an artery increases the severity of symptoms. After elimination of chronic insufficiency and destruction of blood clots, intracerebral circulation is restored.

Symptoms of cerebral ischemic attack

The clinical picture of TIA depends on the location of the damaged cerebral vessel.

Manifestations of vertebrobasilar artery obstruction:

Excessive sweating;
Intra-ear noise;
Dizziness;
Coordination disorders;
Local amnesia (memory loss);
Visual disturbances – double vision of objects, loss of areas of the visual image, light flashes;
Occipital pain.

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 tone of facial muscles;
Convulsive contractions of the arms and legs.

A qualified neurologist will be able to determine the area of brain damage based on symptoms.

What is the manifestation of cerebral artery thrombosis?

Symptoms of circulatory disorders in the cerebral arteries:

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

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

How does a TIA differ from a stroke?

Persistent occlusion of the cerebral, vertebral, and 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 bony growths in the area of the semilunar joints are formed, leading to a narrowing of the vertebral artery.

The clinical picture of carotid artery insufficiency appears before a transient attack and is characterized by mild fainting states that increase as osteochondrosis, spondylosis, and uncovertebral arthrosis progress.

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

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

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

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

The first signs of transient cerebral attack

After the first manifestations occur, a thorough diagnosis of the person’s condition is required. The occurrence of any of the described principles is an indication to consult a doctor:

Foci of dyscirculatory encephalopathy;
Short-term disturbances of consciousness;
The appearance of a “veil” before the eyes;
Blindness in one eye;
Hemianesthesia;
Hemiparesis;
Sensitivity disorders;
Tinnitus;
Paleness of the face;
Blueness of the skin;
Occipital pain;
Vegetative-vascular reactions;
Dynamic ataxia;
Nystagmus.

Acute intracerebral circulatory disorders (stroke) can be prevented if prevention is started in a timely manner.

Recovery from a transient attack

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

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 a transient ischemic attack.

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

Anti-cholesterol diet;
Normalization of coagulation system disorders;
Correction of glucose metabolism;
Symptomatic treatment of disorders.

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

Diagnosis of TIA

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

MR or CT angiography allows visualization of damage to the blood vessels of the brain - procedures for contrast examination of the arteries after the injection of contrast into the vein. Simultaneously with assessing 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 coagulogram;
Biochemical analysis.

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

The term “ischemic attack” is the modern name for transient cerebrovascular accidents in accordance with the International Statistical Classification ICD-10. The paroxysmal manifestations or “attacks” that a person experiences are temporary (transient) in nature and often go away 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 for neurological symptoms is 24 hours. If cerebral insufficiency lasts longer, the condition is regarded as a stroke.

Therefore, doctors consider types of transient ischemic attacks (TIAs) as a very likely harbinger of acute ischemic stroke. The name microstroke has become popular among people. It is practically important to begin intensive therapy during this period. Rational treatment allows you to avoid serious consequences.

International classification

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

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

Their variants reflect the most common localization of short-term mechanical obstruction in the arteries supplying the brain:

G45.0 - level of the vertebrobasilar arterial system;
G45.1 - impaired blood supply to the cerebral hemisphere due to temporary occlusion 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 - code is used in the diagnosis if signs of TIA are present, but the causes are not specified.

What happens in the blood 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 reaction, a failure of the “control” function of the cortical nuclei.

Perhaps their negative role is played by:

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 interruption in the supply of brain cells (neurons) disrupts the internal energy production process, causes oxygen deficiency (hypoxia), and suspends 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 normal within 24 hours.

Causes and factors contributing to temporary ischemia

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

Men over 50 years of age are most susceptible to attacks;
atherosclerotic changes in blood vessels;
hypertension;
systemic vascular diseases of inflammatory and autoimmune nature (lupus erythematosus, vasculitis);
excess weight (obesity) and endocrine pathology;
diabetes mellitus;
changes in the bony processes of the spine in the cervical region;
heart disease, arrhythmias;
nicotine poisoning from smoking;
the effect of alcohol.

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

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

Clinical manifestations

Symptoms of TIA are determined by the location of the lesion. In diagnosis, they indicate a dysfunctional area of the blood supply to the brain. In neurology there are:

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

For any dizziness or 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 common manifestation of temporary ischemia (up to 70% of all cases). They have very diverse clinical symptoms. Occur when turning the head or spontaneously.

Cervical migraine syndrome- associated with damage to the vertebral arteries with deforming spondylosis and osteochondrosis of the cervical vertebrae. Manifests:

acute pain in the back of the head and neck with irradiation along the surface of the head in the form of a “helmet” to the eyebrows;
dizziness and fainting;
nausea;
tinnitus.

Vestibular disorders- a feeling 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 cramps in the arms and legs without loss of consciousness, extension and stretching of the limbs occurs.

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

Transient speech disorders.

Paroxysmal contractions of the diaphragm - cause coughing attacks, hypertension, palpitations, lacrimation 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. Characteristic symptoms:

headaches;
short-term disturbance of consciousness or orientation;
temporary acute weakness and loss of sensitivity in the arms and legs (muscle hypotonia and paresthesia);
mild speech disturbances are possible.

Signs of aortic-cerebral attacks

When blood circulation is disrupted in the area of the aorta to the outgoing carotid and vertebral arteries, the attacks are of a more severe carotid-vertebral nature. Patients develop:

short-term darkening of the eyes;
dizziness and noise in the head;
spatial orientation is impaired;
sudden weakness in the limbs;
speech disorders.

Pathology can occur with coarctation of the aorta. In this case, against the background of high blood pressure, the following occurs:

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

Manifestations intensify when changing the position of the head.

The tinnitus is painful

Attack Severity Criteria

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

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

Diagnostics

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

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

The examination plan should include:

peripheral blood analysis;
biochemical tests indicating the functioning of the liver and kidneys, the presence of tissue necrosis;
lipid profile with determination of the ratio of high and low density lipoproteins, triglycerides;
detailed coagulogram to study coagulation processes;
urine analysis to confirm liver and kidney function, identify elements of inflammation, impaired permeability of the vascular wall;
Dopplerography of the arteries of the neck and brain will allow you to determine changes in blood flow speed, the initial stage of atherosclerosis, narrowed zones, space-occupying 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, and the development of the network of auxiliary vessels;
an electroencephalogram allows you to distinguish signs of vascular pathology from other organic brain lesions;
An electrocardiogram helps identify arrhythmias, myocardial diseases and impaired contractility of the heart.

Magnetic resonance imaging (MRI) and computed tomography are performed to exclude a connection between symptoms and tumors, the presence of intrathecal hematoma

An ophthalmoscopic examination of the fundus of the eye, which is carried out by an eye doctor, is used as a “mirror” of the cerebral vessels.

To make a correct diagnosis and prescribe treatment, the participation of several specialists is necessary, including a therapist, neurologist, ophthalmologist, and cardiologist.

Treatment

The main goal of treatment is to prevent stroke. Therefore, it is necessary to start therapy early, without waiting for severe ischemic attacks and their recurrence.

Hospitalization is necessary for frequent attacks that impair 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 at the clinic.

Directions of therapy:

for blood thinning, such popular drugs as Aspirin, ThromboAss, Cardiomagnyl are recommended; if due to concomitant stomach diseases they are poorly tolerated, Ticlopedin is prescribed;
in stationary conditions, Reopoliglucin is administered 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 lytics are used: Papaverine, nicotinic acid, Nikoverine;
drugs that restore microcirculation of cerebral vessels include Cavinton, Vinpocetine;
Nootropics (Piracetam, Nootropil, Cerebrolysin) help preserve neurons and provide them with additional energy for recovery.

The drug, coming from Germany, requires caution in use in patients with kidney disease, liver disease, and diabetes mellitus

Recently, there has been a debate 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 prescription is considered justified if a two-month strict diet does not lead to normalization of blood cholesterol levels. And if the lipoprotein content is normal, there is no need to use them.

It is necessary to monitor blood pressure levels and take medications for hypertension, diuretics if indicated. Patients with diabetes mellitus cannot get rid of transient attacks without maintaining normal blood glucose levels with the help of hypoglycemic drugs.

If the initial phenomena of thrombosis are detected in a hospital setting, fibrinolytic therapy is carried out in an attempt to dissolve and remove the thrombosis.

Auxiliary therapies:

if there is a connection between ischemic attacks and cervical osteochondrosis, electrophoresis with drugs that relieve muscle spasms, careful massage of the collar area, Darsonval currents on the head are prescribed;
Oxygen, pine, and radon baths have a good relaxing effect; they are best carried out in courses in sanatorium conditions;
physical therapy helps restore impaired blood circulation and develop a network of auxiliary vessels.

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

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

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

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

Therefore, the demands of doctors to go to the hospital, even if the symptoms have disappeared, clearly provide 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 beyond doubt and is confirmed by the number of participants

There is no need to rely only on medications without following personal protection rules. The consequences depend on a person’s lifestyle more than on medications. Recommended:

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

Transient ischemic attacks should be treated as a warning signal about an increasing risk of stroke. By listening to the “signals” of your body, you can avoid severe pathology, prolong your active life and not be a burden to your family and friends.