The following are the ferry results:
abstract
Transient ischemic attack refers to transient cerebral blood circulation disorder, accompanied by focal symptoms, characterized by recurrent transient aphasia, paralysis or sensory disturbance, and the symptoms and signs disappear within 24 hours.
Etiology, pathology and pathogenesis
This disease is mostly related to hypertensive arteriosclerosis, and its onset may be caused by many factors.
(1) microthrombosis: thrombus, hardened plaque, blood breakdown products and platelet aggregates attached to atherosclerotic stenosis of internal carotid artery and vertebral-basilar artery system fall off and block the cerebral artery. Ischemic symptoms disappear when the embolus ruptures or moves distally.
(2) Cerebral vasospasm: Atherosclerotic plaque in internal carotid artery or vertebral-basilar artery system narrows the vascular cavity and produces vortex. When the vortex accelerates, it stimulates the blood vessel wall and causes vasospasm, which leads to transient ischemic attack. When the vortex slows down, the symptoms disappear.
(3) Changes of cerebral hemodynamics: When the carotid artery and vertebrobasilar artery system are occluded or narrowed, if the patient suddenly has transient hypotension, the cerebral blood flow will decrease, which will lead to the onset of this disease; Symptoms disappeared after blood pressure increased. This disease is common and prone to occur when blood pressure fluctuates. In addition, arrhythmia, atrioventricular block and myocardial injury can also cause a sudden decrease in regional cerebral blood flow.
(4) The cervical artery is twisted, too long and knotted, or the vertebral artery is compressed by cervical hyperosteogeny, which can cause the onset of this disease when turning the head.
clinical picture
Older people over 60 years old are more common, with more men than women. It often happens in the case of body position change, excessive activity, sudden rotation or flexion and extension of the neck.
(1) The incidence of TIA in carotid artery system is lower than that in vertebrobasilar artery system, but it lasts for a long time and is easy to cause complete stroke. The most common symptoms are hemiplegia, hemiplegia, hemiparalysis, aphasia, monocular visual impairment and so on. Syndromic hemianopia and syncope may also occur.
(2) TIA in vertebrobasilar artery system is more common than TIA in carotid artery system, with more attacks but shorter time. The main manifestations are ischemia of brain stem, cerebellum, occipital lobe, temporal lobe and proximal spinal cord. The symptoms of neurological deficit are dizziness, nystagmus, unsteady standing or walking, blurred or distorted vision, visual field defect, diplopia, nausea or vomiting, hearing loss, bulbar palsy, cross paralysis, hemiplegia and bilateral mild paralysis. A few people may have disturbance of consciousness or collapse.
Diagnosis and differential diagnosis
The clinical manifestations of the disease are sudden, repetitive, transient and rigid, and the diagnosis is not difficult. It should be differentiated from dizziness and syncope caused by other acute cerebrovascular diseases and other reasons. For the latter, please refer to 12.
prognosis
This disease is often a precursor to cerebral thrombosis. About half of patients with carotid TIA had a complete stroke within 65438 0 months, and 25 ~ 40% within 5 years. About13 epileptic seizures disappear naturally or continue. Old age, infirmity, hypertension, diabetes and heart disease all affect the prognosis. The main causes of death are complete stroke and myocardial infarction.
treat cordially
The disease can be relieved by itself, and the treatment focuses on preventing recurrence. We should adjust blood pressure, improve cardiac function, maintain effective blood circulation, correct abnormal hemorheology, avoid excessive neck flexion and extension, and take anti-platelet aggregation agents orally for a long time, such as aspirin 0.05 ~ 0. 1g, 1 ~ 2 /d, or dipyridamole 25mg, 3 times /d or sulfimazolone 0.8g/d ...
Common sense of prevention:
The appearance of transient ischemic attack is characterized by microembolization of cerebral arterioles, decreased blood flow, ischemia of local brain tissue, numbness and dizziness of limbs and other clinical symptoms. Then, due to the regulation of cerebrovascular itself, cerebral ischemia improved in a short time and the symptoms disappeared. According to medical research, arteriole stenosis in the brain is caused by small pieces falling off the intima or endocardium of atherosclerosis or carotid atherosclerotic plaque flowing to the arteriole in the brain or the cerebral artery itself with blood flow. If the above reasons are not ruled out, transient ischemic attack will recur or even completely block the artery, causing a major stroke. Therefore, its treatment is not only to treat this disease, but also very important to prevent the occurrence of major stroke. Huoxuesu oral liquid has a good effect on improving microcirculation. Aspirin and Likan suppository are considered to be effective antiplatelet drugs at present, which are effective in the treatment of this disease. Dipyridamole can be combined with aspirin; Anticoagulants can be used to treat transient ischemic attack, but there is a risk of serious bleeding, which requires doctor follow-up and laboratory monitoring. Low molecular dextran has the function of reducing blood viscosity and improving microcirculation, and is widely used in clinic. In patients with hypertensive transient ischemic attack, when using antihypertensive drugs, the blood pressure should be lowered slowly, and maintained at about 21.3 kPa (150-160mmhg). Too low blood pressure can lead to a serious stroke. Vascular surgery for patients with transient ischemic attack is very common in foreign countries, mainly including carotid endarterectomy, balloon angioplasty, extracranial internal carotid artery bypass surgery and so on.