Expert: Nie Zhiyu (Neurology Department)
Suddenly, his hands and feet were weak, he couldn't speak, his face was crooked and his mouth was crooked. His family suspected that it was a stroke and rushed to the hospital. However, when he arrived at the emergency department, these symptoms disappeared again. The brain CT and magnetic vibration were checked, and no cerebral hemorrhage or cerebral infarction was found. There was nothing wrong with this test, but at that time, it looked like a stroke. Later, the doctor told me that it might be a transient ischemic attack, which made the family puzzled. What was the transient ischemic attack? Why does it look like a stroke?
what is a transient ischemic attack?
transient ischemic attack, also known as TIA, is commonly known as "pawn". It is a transient neurological dysfunction caused by focal ischemia of brain, spinal cord or retina without acute cerebral infarction, which is characterized by transient aphasia, hemiplegia, limb numbness and dizziness. Different from acute cerebral infarction, most of the symptoms of TIA relieve themselves after 5-1 minutes, usually less than 1 hour, and imaging examination does not leave any imaging evidence of cerebral infarction. Traditionally, TIA lasts less than 24 hours.
why does TIA happen?
TIA attacks are often caused by the embolus falling off after the rupture of cerebral atherosclerotic plaque, or the microemboli of cardiogenic origin (common in atrial fibrillation) falling off. After the embolus flows into the brain with blood and embolizes a certain blood vessel, neurological deficit symptoms such as hemiplegia and aphasia suddenly appear. When the embolus moves to the distal end or dissolves itself, the nerve function recovers, and there is no lesion in histology. There are also some hemodynamic disorders caused by arteriolar stenosis or vasospasm, such as decreased blood pressure fluctuation and decreased cardiac output, which lead to decreased blood flow at the distal end of stenosis and further lead to brain dysfunction.
which groups are prone to TIA?
The risk factors of TIA and cerebral infarction are the same, including hypertension, diabetes, hyperlipidemia, smoking, alcoholism, obesity and family history. Men are more common. After the age of 45, with the increase of age, the risk of TIA and cerebral infarction is gradually increasing.
what are the hazards of TIA?
The risk of cerebral infarction is obviously increased in any TIA patient. Cerebral infarction is a disease with the highest disability rate. Its high disability rate, high recurrence rate and high mortality rate bring heavy burden and great pain to society, families and patients. Therefore, TIA is a dangerous signal of cerebral infarction and should be paid enough attention to. Once TIA occurs, you must go to the hospital immediately.
TIA and the early symptoms of cerebral infarction are also very similar, and they can only be distinguished by brain magnetic resonance imaging or with the passage of time. Although the symptoms of TIA can return to normal on their own, they cannot be ignored. Because the risk of recurrence or cerebral infarction in patients with TIA is very high, the risk of cerebral infarction in patients with TIA within the second, seventh, thirtieth and ninetieth days after onset is 3.5%, 5.2%, 8.% and 9.2% respectively. Therefore, once TIA is suspected, it is necessary to see a doctor, find out the cause, and carry out appropriate medical or surgical treatment to prevent acute cerebral infarction in the future.
how to identify TIA?
there are many clinical manifestations of TIA. Different patients have different clinical manifestations after onset. Patients may suffer from hemiplegia, aphasia and numbness of limbs, as well as dizziness, nausea and vomiting. This is mainly related to the different locations of ischemic blood vessels and brain tissue in patients.
The blood supply to the brain is responsible for two vascular systems: one is the internal carotid artery system, and the other is the vertebral-basilar artery system. According to the damaged blood supply system and brain tissue, the symptoms of TIA are also very different.
The internal carotid artery system supplies blood to the first two-thirds of our brain, and its blood supply is mainly divided into two parts, one is the middle cerebral artery and the other is the anterior cerebral artery. There is a problem with this system. The patient may have transient clumsiness or weakness in one limb, transient numbness in the limb, and skew in one face. Transient monocular blindness and blurred vision can occur; There can also be transient slurred speech, or even inability to speak.
The vertebrobasilar artery system is mainly responsible for the blood supply to the back third of our brain (including brain stem and cerebellum). If the vertebrobasilar artery system is involved, the most common symptoms are dizziness, nausea and vomiting, and some patients will be accompanied by tinnitus. Patients can also have visual impairment, visual field defect, or diplopia, that is, double vision. If the basilar artery segment is involved, the patient may suddenly lose consciousness. If the medulla oblongata segment of the brain stem is involved, the patient may suddenly become hoarse or unable to make a sound, and some may be accompanied by swallowing difficulties and choking on drinking water. If the reticular structure of brain stem is involved, the patient will have a fall attack. In the event of a fall, most patients can suddenly fall to the ground when their heads are turned or their heads are raised, but there will be no disturbance of consciousness, and they can stand up on their own after falling, and there will be no limb weakness afterwards. Patients can also have transient total amnesia, and patients may suddenly lose their memory for a short time, but they can know the time and place at that time.
what should I do after TIA?
once you suspect TIA, you should immediately call 12 to go to a hospital with the qualification of a stroke center. The doctor will make a diagnosis of TIA on the basis of asking about medical history, physical examination and other auxiliary examinations, and combining with the risk factors of stroke. Once TIA is confirmed, it is necessary to find its etiology and prevent recurrence.
First of all, after excluding cerebral hemorrhage, it is suggested that patients with non-cardiogenic TIA take antiplatelet aggregation drugs, such as aspirin and clopidogrel. For patients with cardioembolic TIA (accompanied by atrial fibrillation, rheumatic mitral stenosis, artificial heart valve implantation, etc.), oral anticoagulants such as warfarin are recommended. If carotid stenosis is found, surgery may be needed.
Secondly, it is to control risk factors such as hypertension, diabetes and hyperlipidemia.
how to prevent TIA?
for people who have never had TIA, the key to prevention is to eliminate the potential risk factors or minimize them. Such as controlling hypertension, diabetes and hyperlipidemia, quitting smoking and losing weight through diet, physical exercise or medication.
Finally, I hope everyone can pay attention to health and stay away from these high-risk factors.
Expert's business card
Nie Zhiyu
tongji hospital affiliated to Tongji University
Chief physician, professor and doctoral supervisor
Expert clinic: Thursday morning
Special clinic: Monday afternoon
Areas of expertise: first aid, standardized diagnosis and secondary prevention of cerebrovascular diseases; Diagnosis and treatment of Parkinson's disease; Epilepsy; Headache; Nervous system diseases such as facial paralysis.
Currently, he is the executive director of tongji hospital Neurology Department affiliated to Tongji University. He is also a member of the Stroke Prevention and Control Committee of the Chinese Preventive Medical Association, a member of the Stroke Branch of the Shanghai Medical Association, a member of the Cardiovascular and Cerebrovascular Diseases Committee of the China Gerontology Society, a member of the Cerebrovascular Diseases Group of the Shanghai Neurology Branch, a member of the Fifth Neurological Committee of the Shanghai Society of Integrated Traditional Chinese and Western Medicine, and a member of the Standing Committee of the First Professional Committee of the Shanghai Society of Integrated Traditional Chinese and Western Medicine. Standing Committee member of the 4th Neurorehabilitation Professional Committee of Shanghai Rehabilitation Medical Association, member of Cardiovascular and Cerebrovascular Diseases Group of China Emergency Branch, member of 6th World Stroke Congress (WSC), member of Cerebrovascular Diseases Group of Shanghai Neurology Branch, standing Committee member of the 1st Committee of Neurology Professional Committee of Bethune Medical Expert Committee, Member of the First Committee of Neurophysician Branch of Shanghai Medical Doctor Association, Member of the Second Committee of Neurology Experts of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiovascular and Cerebrovascular Diseases for the Aged, Editorial Board of China Journal of Stroke, and Editorial Board of China Journal of Neuroimmunology and Neurology.
Since my work, I have presided over more than 1 projects, including general projects of National Natural Science Foundation, projects funded by Shanghai Science and Technology Commission, projects funded by Liaoning Education Commission and projects funded by Shanghai Health Bureau, published more than 12 papers, and edited 16 books. I have been engaged in medical treatment, teaching and scientific research in the neurology department of 3A hospitals for 3 years, and have accumulated rich experience in the treatment of intractable diseases and critically ill patients. I have successfully diagnosed and rescued many patients with severe stroke, Guillain-Barre syndrome, myasthenia gravis, cerebral venous sinus thrombosis and other diseases, and given clear diagnosis to patients with diabetic ophthalmoplegia, lateral femoral cutaneous neuritis and special types of myasthenia gravis who have been running around in many hospitals, thus relieving their troubles.
Text | Neurology
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