Transient Ischemic Attack

Transient Ischemic Attack

A transient ischemic attack ( TIA for short ) occurs as a result of a circulatory disorder in the brain. The attack leads to reversible neurological deficits.

What is a transient ischemic attack?

In a transient ischemic attack ( TIA ), the blood flow to the brain is disrupted. The symptoms are similar to those of a stroke. That is why the TIA is also referred to as a small stroke. The neurological disorders resulting from a microembolism in the brain resolve within 24 hours. On average, the attacks last one to two hours.

Any neurological deficit lasting longer than 24 hours suggests an ischemic stroke. The attacks occur most frequently between the ages of 60 and 70. The transient ischemic attack can be interpreted as a harbinger of a real stroke and should therefore be urgently clarified by a doctor. For slang hypertriglyceridemia, please visit electronicsencyclopedia.com.

In the first two hours after a TIA, the risk of a stroke increases by ten percent. In the first two weeks, the risk increases by an additional five percent. One in three patients with a transient ischemic attack will suffer a stroke in their lifetime. Half of all strokes occur in the year after the TIA.

Causes

A TIA is caused by a lack of oxygen supply to certain areas of the brain. This undersupply is also referred to as ischemia. Ischemias are caused by microcirculatory disorders in the cerebral vessels. Microembolisms of cerebral blood vessels are mainly responsible for the circulatory disturbances. It has been found that many TIAs are caused by minor strokes.

The causes are therefore similar to the causes of a stroke. Arterial embolisms of the blood vessels often occur. Thrombosis of the venous drainage vessels can also result in ischemia. If blood vessels rupture as a result of high blood pressure, for example, the brain is not supplied with enough oxygen.

The bleeding also results in neurological failure symptoms. A TIA can also develop in the case of spontaneous bleeding from impaired blood coagulation, subarachnoid hemorrhage, and subdural or epidural hematomas. The attacks are rarely triggered by vascular spasms, such as in a migraine attack.

Symptoms, Ailments & Signs

The symptoms of a TIA are similar to the symptoms of a full stroke. However, they are usually not quite as pronounced. One-sided arm and leg paralysis are characteristic. In medical jargon, these are also referred to as hemiplegia or hemiparesis. Those affected may have speech disorders. Language comprehension and word finding are impaired.

Word confusion disorders and new word creations can be found in spontaneous speech. Some of the patients have a compulsive urge to express themselves verbally (logorrhea), resulting in an uninterrupted and rapid flow of speech. In addition to speech disorders, there may also be speech disorders. In the case of a speech disorder, those affected can no longer articulate speech sounds correctly. The flow of speech can be disrupted by stuttering or stuttering.

Amaurosis fugax, or temporary blindness, can result from microembolisms in the retinal vessels or in the area of ​​the optic nerves. Hearing disorders and balance disorders with dizziness and so-called drop seizures can also occur. Drop attacks are sudden falls in a normal state of consciousness. They are caused by a loss of tone in the leg muscles.

The patient ‘s consciousness may be clouded. If it really is a TIA, the symptoms resolve completely within 24 hours. For the brain, ischemia is tolerable within a time window of five to eight minutes. If the ischemia is prolonged, the symptoms do not resolve. In this case there is a stroke.

Diagnosis & course of disease

Since the symptoms usually don’t last very long, a TIA can be difficult to diagnose. The focus of diagnostics is therefore placed on the anamnesis and clinical examination. If the patient is known to suffer from cardiac arrhythmia or coronary artery disease, this strengthens the suspicion of a TIA if reversible neurological symptoms are present.

Magnetic resonance tomography with diffusion weighting can be used as an imaging method. In this way, brain tissue with insufficient blood flow can be diagnosed. However, the sensitivity is only 50 percent, so that not every undersupply is detected. Other imaging methods used to diagnose TIA are Doppler sonography of the extracranial cerebral vessels, transcranial Doppler ultrasound examination, computed tomography, magnetic resonance angiography and digital subtraction angiography.

Complications

This condition can lead to various symptoms and complications. These depend very much on the exact form of the disease. In general, the patients suffer from a severe circulatory disorder in the brain. This leads to speech disorders and general thinking disorders. The everyday life of those affected is therefore significantly more difficult and restricted.

In many cases, the patients also suffer from stuttering and also from hearing or vision problems. In serious cases, they depend on the help of other people in their lives. There is clouding of consciousness and further loss of consciousness.

The muscle tone also decreases significantly as a result of the disease, so that those affected can no longer carry out simple everyday activities. It can also lead to a stroke, which in the worst case can lead to the death of the patient. This disease is treated with medication. There are no further complications.

However, this does not completely limit the symptoms, so that a stroke can still occur. This significantly reduces the life expectancy of those affected. The relatives or parents of the patient can also be affected by these symptoms.

When should you go to the doctor?

Behavior abnormalities, balance disorders, dizziness or general functional disorders must be reported to a doctor immediately. If there are changes in the ability to speak, a reduction in vision and irregularities in memory, there is an acute need for action. In the event of sudden peculiarities or abnormalities, medical care is required as quickly as possible.

A word-finding disorder and a decrease in language comprehension are warning signals from the organism. They indicate a memory disorder. If there is a clouding of consciousness or a loss of consciousness, an emergency service must be alerted. The situation is life-threatening for the person concerned.

Although the attack resolves completely in most patients, an unfavorable course of the disease can lead to a stroke. Therefore, consultation with a doctor should always be sought and a comprehensive examination initiated. If there are disturbances in the movement sequences, difficulties in coordination and a loss of muscle strength, a doctor is needed.

A feeling of illness, a decrease in mental performance or a general feeling of being unwell should also be examined and treated. Paralysis or compulsive acts are causes for concern. Talking incessantly and a very fast flow of speech are characteristic. Those affected often do not allow themselves to be interrupted in their torrent of speech. Medical help must be sought to prevent further deterioration of health.

Treatment & Therapy

As long as the symptoms of the TIA persist, treatment is the same as for a stroke. An attempt is made to dissolve the embolus with medication. Special drugs called fibrinolytics are used for this. If drug treatment is unsuccessful, surgical intervention, thromboendarterectomy, may be indicated.

Once the symptoms of the TIA have disappeared, the focus is on preventing further attacks. The transient ischemic attacks are often the harbingers of a “big” stroke. The ABCD2 score is used for risk assessment. This score includes the five risk factors of age, blood pressure, symptoms, duration of symptoms and diabetes mellitus.

Depending on the criterion, different points are awarded, so that a total score of between zero and seven can be achieved. The ABCD2 score provides information about the risk of suffering a stroke within two days after a transient attack. A score of zero to three indicates a low risk.

Four to five points represent a moderate two-day risk and six to seven points represent a high two-day risk. With six to seven points, the probability that the patient will develop a stroke within two days is eight percent.

Prevention

Anticoagulants are given to prevent another TIA. Surgery on the vessels supplying the brain can improve blood circulation and thus prevent further attacks.

Aftercare

After treatment of a transient ischemic attack, especially if the cause is atherosclerosis, it may be essential to take blood-thinning medication (Macumar) to prevent possible strokes and heart attacks. It is important to check the Quick and INR levels in the blood regularly to prevent the blood from becoming too thin. If you have high blood pressure, you should also take antihypertensive medication.

In addition, regular follow-up examinations of the brain (MRT, CT) but also of the heart (ECG) by the appropriate specialists are extremely important in order to identify vascular constrictions and possible reduced blood flow at an early stage and thus prevent another transient ischemic attack, but also heart attacks and strokes. Patients should also refrain from smoking.

The nicotine contained in tobacco constricts the blood vessels and the carbon monoxide inhaled through the tobacco smoke also sticks together the blood platelets. Alcohol consumption should be avoided, as alcohol also has a vasoconstrictive effect and also increases blood pressure. In addition, sporting activity promotes blood circulation and lowers blood pressure in the long term.

The extensive avoidance of salt, which is particularly found in finished products, but also in snack foods (crisps, pretzel sticks, crackers) and a low-vitamin-K diet (avoidance of green vegetables such as kale and broccoli) also help to improve blood circulation and prevent serious secondary diseases avoid.

You can do that yourself

Even if the symptoms disappear completely within 24 hours, the TIA is always to be seen as a harbinger of an apoplexy. In order to avoid this, those affected should minimize the risk factors and develop positive compliance.

Since the causes of a transient ischemic attack are usually eliminated with the help of medication, medication training is important. Affected people have to learn which preparations they have to take when and who they should inform about the application. Furthermore, aftercare is an important part of curation and prevention. Physicians should make the patients aware of the importance of the appointments.

The risk factors that lead to a TIA can be diverse. People with diabetes should aim for an HbA1c of less than 8% in order to delay the long-term effects of the disease. People with hypertension minimize the risk of apoplexy many times over if the average systolic value does not exceed 140 mm Hg and the diastolic value does not exceed 90 mm Hg.

Arteriosclerotic deposits, which can be traced back to increased LDL consumption, can be reduced enormously by those affected by changing their eating habits. Because a diet low in fat and cholesterol and high in fiber and vitamins prevents new deposits on the one hand and existing deposits on the other are dissolved. If the cause of the ischemia is excessive alcohol consumption, sufferers can use withdrawal to reduce the risks of secondary diseases.

Transient Ischemic Attack