Transient ischemic attack is a transient or transient focal cerebral or retinal dysfunction caused by intracranial vascular lesions characterized by recurrent episodes of transient aphasic paralysis or sensory impairment lasting several minutes each time herbal medicine usually recovers completely within min.
Since the beginning of the century, there has been an awareness of transient stroke-like episodes, and the literature at that time was mainly concerned with the clinical and pathological documentation of some cases, such as William Savry’s description of a woman with infectious arterial disease who had a possible recurrence of left-sided limb weakness within a year. It was only in the century that transient ischemic attack replaced other definitions of fatigue and was accepted this time.
Although transient ischemic attack in the imaging (CTMRI) examination and moderation should not be detected in the process of what lesion enthusiasm symptoms are not heavy know life can take care of themselves but secondary stroke rate death rate and disability are not low prognosis treat very poor statistics show that transient ischemic attack the chances of stroke occurrence significantly beaten higher than the responsibility of the general population people figuratively compared it to a prelude to a stroke according to reports transient One-third of patients with transient ischemic attack are impatient to have a stroke and one-third keep having new attacks; about two years after the onset of transient ischemic attack about % of patients who do not understand will die years after the onset more about % of patients mean will die [] []
Causes around the onset of the disease
(1) Atherosclerosis of the arteries supplying the cerebral blood circulation is the most common cause of transient ischemic attacks, and the most common cause is atherosclerosis of the carotid arteries, which often leads to narrowing of the lumen and reduces blood flow to the brain.
(2) Arterial-arterial thromboembolism: emboli originate from the ulcerated surface of atherosclerotic plaques in the carotid or vertebral arteries of the neck or, less frequently, from the attached thrombus in the concluding heart; the most common causes of cardiogenic emboli are atrial fibrillation valve disease and left ventricular thrombosis, etc.
(3) less common causes oral: ① clamping aneurysm arteritis and abnormalities of blood components (such as true erythrocytosis thrombocytopenia anti-cardiolipin antibody syndrome, etc.); ② hemodynamic changes: blood flow has a transient reduction such as any painful cause of special hypotension arrhythmia subclavian artery steal syndrome and warm drug adverse reactions; ③ complications of interventional and normal surgical drug therapy for cardiac immaturity ; ④ hypertension atherosclerosis useful heart disease diabetes mellitus as well as hemoglobinopathy all contribute easily to the occurrence of transient ischemic attack []
Clinical presentation
Prevalent population
The incidence of transient ischemic attack in general medical practitioners is not low, and the annual incidence of transient ischemic attack is ~ per person in the normal medical population.
Symptoms of the disease
Due to the different sites of ischemia, the manifestation is often a transient black haze in front of the eyes, black spots in the visual field, shadows in front of the eyes, reduced light or weakness and numbness in one side of the face or limbs, sometimes also showing a combination of symptoms such as vertigo, dizziness, migraine, falls, ataxia, diplopia, hemianopia or bilateral vision loss.
Disease diagnosis inquire
Transient ischemic attack develops into stroke then good luck treating other more tricky key is prevention how to emphasize as much as and not too much transient ischemic attack is one of the most valuable emergencies in the arrangement of cerebrovascular disease treatment once it occurs must be immediately sent to the hospital excellent okay treatment because of the unique “guidance time dedication is the brain” correct original Treatment praise transient ischemic attack has become the most powerful measure to prevent permanent stroke early and timely appropriate blessing therapist table can make most transient ischemic attack does not develop into permanent stroke first consider a comprehensive diagnosis and treatment examination injury should emphasize the ability to do the following tests as early as possible: ① neuroimaging and non-invasive Doppler ultrasound health examination to determine whether there is damage to the brain tissue of very high patients ② blood test to assess how fast the blood clotting cure ③ electrocardiogram results examination to determine whether the patient does not want to have a shielding heart attack or whether there is a heart minute rhythm disorder at the same time need to actively prevent reincarnation treatment; countless lastly to carry out education about stroke causes risk factors arrangement symptoms such as diet education exercise therapy education useful drug refusal treatment education mental health very high education functional training education and discharge a bunch and guidance, etc. [] []
Disease follow-up and treatment
Currently should be based on the same patient perspective etiology clinical side effects systemic condition imaging seen and hematological examination oral and selected drugs individualized myriad treatments available for transient ischemic attack consultation treatment are as follows.
Drug difficult etiology treatment
Anti-platelet coagulants for the protection of cerebral perfusion to prevent thrombosis ① Aspirin (Aspirin) enteric tablets: the preferred drug injection recommended doubt small dose: mg / d to the evening around the point since to take is appropriate to apply a small dose of aspirin can Thursday inhibit platelet cyclooxygenase effective prevention of cerebral thrombosis reduce transient ischemic attack big put recurrence reduce mortality small dose of aspirin can be effective anti-platelet Anti-platelet aggregation and vasodilatation twice a day each time ~mg orally ④ Pansentin plus aspirin: the only approved combination
Anticoagulation therapy
Heparin can be used but the indications should be understood to monitor prothrombin time during treatment to prevent bleeding; low molecular heparin does not need to monitor prothrombin time; Warfarin can prevent atrial fibrillation in non-valvular disorders
Indications for thrombolytic intravenous administration of tPA: ① onset < h ② frequent transient ischemic attacks ③ laboratory tests show normal blood cell volume platelets ptkptt < p="">
Surgical treatment
Carotid endarterectomy (CEA) and carotid angioplasty and stent placement (CAS) have been carried out more frequently abroad, but their long-term efficacy remains to be observed, and there are only scattered experiences in China. To improve the cerebral circulation, we can use pulsatilla to improve the effect of the Chinese herbal extracts such as Danshen, Sichuan peony, red flowers and Pueraria lobata.
Etiological treatment
For arteriosclerosis hypertension diabetes mellitus cervical spondylosis hyperviscosity hyperlipidemia and other conditions that are likely to cause transient ischemic attack episodes should take appropriate treatment measures [] []
Disease prevention
People at high risk of transient ischemic attack or those who have had transient ischemic attack should pay attention to the following health care in daily life: ① understand the significance of dietary treatment and specific measures, for example, patients with high blood lipids should have a low-fat diet and strictly prohibit the intake of animal oil and try to consume vegetable oil. lower blood sugar to improve cardiopulmonary function to accelerate blood circulation to promote metabolism to improve the overall quality of the body exercise, including walking jogging taijiquan table tennis swimming rowing ball, etc. which shake hands backwards walking jogging and other sports safe and easy for the elderly patients in the exercise to master the intensity of gradual each ~ min daily ③ can be taken under the guidance of doctors enteric aspirin or Pansentine to improve brain circulation at the same time (3) Patients with diabetes mellitus should actively and effectively control blood glucose; patients with hyperlipidemia should use lipid-lowering drugs as early as possible in addition to adjusting the diet structure; (4) Proper understanding of the disease can eliminate anxiety, tension, fear and other negative emotions, thus positively influencing the treatment effect; (5) After comprehensive treatment, most patients can recover limb function. However, it is also necessary to frequently carry out functional exercises of the upper limbs, which can be done by holding the hands behind the body so that the hips can be pushed forward as much as possible and stretching the entire spine; Also pay attention to the regular review of blood pressure, blood lipids, blood sugar, etc. []
Expert opinion
When people mention the name transient ischemic attack, many people may not think that transient ischemic attack is nothing and will pass in a while. It is a super warning sign of stroke and should be dealt with immediately to reduce the chance of stroke, so as not to delay the best treatment for the patient and cause serious adverse effects.
In short, patients with transient ischemic attacks should be rescued every second, and the need for long-term stroke prevention treatment after transient ischemic attacks has become a growing consensus among neurologists and internists.