Transient ischemic attack: symptoms, treatment, consequences

TIA is a rather acute disturbed blood circulation in the brain, which can manifest itself with some signs of a stroke. However, the difference between a transistor attack and a stroke is that it lasts for a short time, and also has no mental or physical consequences for a person.

In most cases, TIA episodes last no more than 3-5 minutes, however, there are cases when their duration reached a day. The consequences of an ischemic attack can be severe. Often it is confused with a micro- or ischemic stroke, since they have very similar causes. Simply put, TIA is the first and rather revealing warning about the risk of developing a stroke.

Further details on the treatment and symptoms of ischemic transient type of brain attack next.

Physiology of the disease

Typically, TIA results from a decreased ability of blood vessels to provide neurons with such necessary oxygen. This disease can have a very different severity, so it is often difficult for doctors to draw a line between an ischemic stroke and a transient attack, since these diseases develop almost identically.

One, the most effective criterion is known, which allows to distinguish TIA from a stroke - an attack never lasts 24 hours, which often happens in the presence of a stroke.

Reasons for TIA:

1. Violation of the rhythm of the heart system and the formation of blood clots, which can separate into particles, and enter the arteries with blood flow, thereby causing a violation of blood flow.
2. Atherosclerosis of the brain: cholesterol is deposited on the walls of arteries. There is a narrowing of the vascular lumen, due to which the blood supply to the brain is disturbed, the development of atherosclerotic plaques may be noted.
3. The formation of blood clots in the veins of the legs, which can also be divided into particles, getting into the arteries with blood, causing impaired blood flow in the brain.
4. Pressure reduction.
5. Compression of arteries that saturate the brain with blood: this mainly occurs during surgical interventions on the carotid artery, or a strong turn of the head.
6. Blood thickening.
7. The risk of thrombosis, especially with developing antiphospholipid syndrome, directed against their own cells and red blood cells.

Also, signs that may provoke a high risk of the disease include certain features of the patient's life: obesity, alcohol and tobacco dependence, as well as a sedentary lifestyle.

The above factors can have a negative effect on the vessels of the brain, which can narrow or lose their elasticity. If the vessels are not able to provide the brain cells with sufficient nutrition, a person may develop such a disease.

Signs of TIA

Symptoms of a transient ischemic attack of the brain may be different, depending on one of the two vascular pools where the blood flow is disturbed. More details about these pools will be described below.

Carotid pool

It is formed by the carotid arteries that are located inside. Promotes blood supply to the hemispheres of the brain, which control nervous activity, and are also responsible for the increased sensitivity of the body and its motor activity. If blood circulation is disturbed in the carotid pool, the patient may be disturbed by the following signs of an ischemic attack. And there are many of them:

• Paralysis of the face, which is noticeable when you smile or raise your eyebrows up (asymmetrical wrinkling of the forehead on the sides).
• Impaired mobility of the limbs, especially one-sided, or paralysis of the whole body.
• Dysarthria is inarticulate and fuzzy speech.
• Motor aphasia - it is difficult for a person to pronounce words: he knows about the defectiveness of his words, therefore he tries to be laconic.
• Sensory aphasia - the patient does not understand the speech addressed to him: he looks disoriented, because he does not understand the speech of strangers. The patient may speak, but his speech is meaningless.
• Mutism - speech is completely absent.
• The mobility of the eyeballs on the sides is limited, they can be completely immobilized.
• Freezing eyes that are directed to the right or left side.
• Partial or total blindness.
• Cognitive impairment: a person hardly understands how much time, what time of year, where he came from, it is difficult for him to count, write and read - the patient confuses phrases and letters in the text in places.

It is worth saying about what it is, paresthesia of limbs. This is one of the symptoms of this disease. Burning and tingling in the limbs, which is characterized by TIA, occurs in 60% of cases. Therefore, you need to know what paresthesia of the extremities is with TIA and do not panic when such a symptom appears.

Vertebrobasilar Pool

It is formed by two arteries located in the spine, and supplies blood to the brain stem, which is responsible for blood circulation, respiration and other vital functions.

In the case of impaired circulation in this pool, the following symptoms of ischemic attack usually occur:

• unsteadiness of the gait: the patient, who is in a standing position, will swing on the sides;
• systemic dizziness, as a result of which the patient tries to hold on to foreign objects to balance, even in a lying or sitting position;
• lack of coordination of movements: they are sweeping;
• impaired mobility of the eyeballs: mobility on the sides is limited, they can even stop moving;
• tremor: performing active movements, the patient has trembling limbs;
• violation of sensitivity: the border that divides the body into two parts is formed by a line that is drawn through the navel and the end of the nose;
• impaired mobility of certain parts of the body;
• nystagmus: eyeballs oscillate on both sides;
• sudden loss of consciousness;
• impaired breathing.

Severity

In our time, the following severities of TIA are known, depending on the duration:

• Mild TIA - An attack lasts no more than 10 minutes. The main symptom is dizziness during an ischemic attack.
• TIA of moderate severity - symptoms persist for a maximum of 10 minutes, and last up to a day. Loss of consciousness during an ischemic attack is the main symptom of this stage.
• Severe TIA - an attack can last a day, organic symptoms can persist after an attack of a transient attack, or all symptoms at once. Hemiparesis in an ischemic attack at this stage acts as the main symptom.

The most pronounced sign of a transient attack is the speed of spread and elimination of the disease. TIA is characterized by a quick start, a short duration, as well as a return to normal. TIA episodes can often recur with similar symptoms.

Diagnosis TIA

To begin with, the doctor carries out an anamnesis of the disease and the patient's complaints: it finds out when complaints about a violation of sensitivity, impaired vision appeared, how much time has passed from the first complaints. It is important that the patient gives accurate information about whether such complaints were repeated with active load, and in a calm state, whether alarming symptoms were noted earlier.

It is also necessary to perform a neurological examination: to identify signs of a neurological problem - loss of vision and sensitivity, as well as the impossibility of limb movement. It is definitely worth performing a blood test to suspect a thickening of blood in time.

The doctor usually prescribes the following procedures:

• MRI and CT of the head: these methods allow you to layer by layer, as fully as possible to obtain data on the structure and construction of the brain. With a transistor attack, distinctive from a stroke, they do not find special symptoms of existing pathologies in the brain.
• An ECG allows you to detect signs of a malfunction in the heart.
• Ultrasound of extracranial arteries helps to examine their patency. They are usually located on the neck, and supply blood to the brain.
• Echo-KG is performed to detect blood clots in the heart.
• MRI to assess patency of the cranial arteries.
• TCD makes it possible to evaluate arterial blood flow. In this case, an ultrasonic sensor is applied directly to the temple area.

TIA treatment

Since entering a hospital, it is very difficult to assess what kind of disease a person has - an ischemic stroke or a transient ischemic attack - it is urgent to start a full-fledged treatment.

Typically, a patient with this diagnosis will be hospitalized in neurology to observe and treat with the participation of a psychologist, speech therapist, neurologist and cardiologist (in case of rhythm and pressure disturbance). Without accurate identification of the symptoms of TIA, it will not be possible to reduce the risk of stroke and the development of a repeated ischemic attack.

Typically, medications for an ischemic attack, the symptoms of which are higher, are as follows:

1. Drugs that help lower blood pressure: it is absolutely impossible to lower it in the first day, as this will also reduce the supply of blood to the brain.
2. Thrombolytic treatment - a drug is injected into the bloodstream that will dissolve the blood clots that block the lumen of the cerebral arteries. But it is worth noting that this method has many contraindications, especially if at least 3 hours have passed from the onset of the first symptoms. Thrombolytic therapy may be at risk of gastric, intestinal, or intracerebral hemorrhage due to decreased blood coagulation activity.
3. Drugs to improve blood flow (anticoagulants and antiplatelet agents that improve blood rheology).
4. Antiarrhythmic drugs that help restore heart rate.
5. Neuroprotectors to improve brain nutrition, as well as accelerate its recovery.

First aid for an ischemic attack is to deliver the patient to a medical facility and administer the necessary drug.

Surgical intervention

Treatment after a transient ischemic attack may also consist of the need to perform a surgical operation of one of the following types:

1. Carotid angioplasty with the possibility of stenting: a catheter is inserted into the area of ​​the artery clogged with plaques, having a balloon at its end, which is pumped and pressed to the plaque. A tube with a metal mesh installed in the artery will prevent narrowing of the artery.
2. Carotid endarectomy is used for severe or excessive narrowing of the carotid artery. During the operation, the artery opens, after which it is thoroughly cleaned, and must be closed.

Complications

When an ischemic attack turns into a stroke, a neurological defect forms in the patient:

• dysarthria, in which slurred speech is noted;
• paralysis;
• cognitive impairment - deterioration in cognitive abilities and memory loss.

TIA in children

Usually, this disease is detected in adults, because it depends on the irreversible aging of organs and body tissues. But there are cases of the disease among children, which are facilitated by the following factors:

• deviations of the bloodstream;
• atherosclerosis of the arteries located on the head;
• thrombosis in the valves and heart due to impaired blood coagulation;
• infections
• uncoordinated contractions of the muscles of the heart.

To find out the cause of TIA in a child, you must initially consult a neurologist to perform an MRI and CT scan, as well as an EEG to rule out the occurrence of epilepsy. You also need to visit a pediatrician for a comprehensive analysis, and to check the blood coagulation system. In addition, an analysis is performed for homocysteine, a special amino acid that additionally provokes thrombus formation, and also provokes the appearance of atherosclerosis.

TIA Prevention

To prevent the occurrence of transient ischemic attack, the clinical recommendations are as follows. The patient needs to eat properly, limiting the consumption of fried and fatty foods as much as possible. It is important to control blood pressure through the use of antihypertensive drugs.

Medication methods can also be effective to eliminate rhythm disturbances, special antiarrhythmic drugs are indicated for heart rhythm disturbances, medications that eliminate blood coagulation, as well as drugs to prevent thrombosis, should be taken.

To improve cholesterol metabolism, reduce the activity of the atherosclerotic vascular process, the patient should take statins. Disaggregants are usually taken to reduce blood coagulation. Prevention of repeated transient attacks consists in changing the way of life, as well as timely correction of acute diseases.

In especially severe cases, surgical narrowing of the arteries supplying the brain with sufficient blood is indicated. In case of excessive narrowing of the arteries, and when removing atherosclerotic plaques with the inner lining of the carotid arteries, carotide endarterectomy and extra-intracranial microanastomosis are used to narrow the cranial arteries.

Total

If a person or his relative has already suffered an ischemic attack, he needs to be extremely careful about himself, since there is a risk of further development of a stroke. The first signal of the need for help is a violation of the blood circulation of the brain. You should immediately consult an experienced neurologist in time to identify and eliminate the possible cause of a transient ischemic attack.