Transient ischemic attacks.

The treatment of TIA must be individualized. TIA is one of several manifestations of generalized atherosclerosis. While one-third of patients with TIA will suffer a stroke in five years, one-half of the same group will die of myocardial infarction. The risk of stroke is greater in carotid rather than vertebral-basilar TIA, in older patients, and in those with a cluster of TIAS, an is highest in the first month after the TIA. Treatment should reflect this knowledge.     

Transient ischemic attacks at high altitude

The precise etiology of transient neurologic deficits at high altitude is unclear, particularly since the subjects are not investigated as they would be had the events occurred in an urban environment. This report describes two subjects who experienced transient ischemic attacks (TIAs) while ascending the northeast ridge route of Mt. Everest during the Ultima Thule Everest Expedition, and a third subject with TIAs during three separate high-altitude climbs. Possible etiologies and treatment for TIAs at high altitude are suggested.     

Transient ischemic attacks: Part II. Treatment

Risk factors for stroke should be evaluated in patients who have had a transient ischemic attack. Blood pressure, lipid levels, and diabetes mellitus should be controlled. When applicable, smoking cessation and weight loss also are important. Angiotensin-converting enzyme inhibitor therapy may help prevent stroke. Aspirin is the treatment of choice for stroke prevention in patients who do not require anticoagulation. Clopidogrel is an alternative therapy in patients who do not tolerate aspirin. Atrial fibrillation, a known cardioembolic source (confirmed thrombus), or a highly suspected cardioembolic source (e.g., recent large myocardial infarction, dilated cardiomyopathy, mechanical valve, rheumatic mitral valve stenosis) are indications for anticoagulation.     

Transient ischemic attacks: Pathophysiology and medical management.

There is substantial evidence to support the concept that most transient ischemic attacks (TIAs) are caused by microemboli that originate in areas of atherosclerosis in the blood vessels of the neck. TIA's are important risk factors in the development of stroke. The most common clinical features of TIAs caused by carotid insufficiency are hemianesthesia and hemiparesis; other symptoms in these cases include headache, dysphasia, and visual field distrubance. By far the most common clinical manifestation of vertebrobasilar insufficiency is vertigo.     

Transient ischemic attacks. Strategies for minimizing stroke risk

In patients with transient ischemic attack (TIA), the risk of stroke increases greatly, especially in the months immediately following the initial attack. Diagnosis of TIA is based primarily on the patient's cerebrovascular history, since results of neurovascular examination are usually normal. TIA is often related to atherosclerotic arterial disease but can have numerous causes. Migraine, focal seizures, and other neurologic conditions can closely mimic TIA. Surgical and medical therapies help minimize the risk of stroke. The choice of therapy depends on the vascular territory of ischemia, the cause of the attack, the patient's medical and neurologic condition, the availability of a skilled surgeon, and other factors.     

Transient ischemic attacks: Part I. Diagnosis and evaluation

Transient ischemic attack is no longer considered a benign event but, rather, a critical harbinger of impending stroke. Failure to quickly recognize and evaluate this warning sign could mean missing an opportunity to prevent permanent disability or death. The 90-day risk of stroke after a transient ischemic attack has been estimated to be approximately 10 percent, with one half of strokes occurring within the first two days of the attack. The 90-day stroke risk is even higher when a transient ischemic attack results from internal carotid artery stenosis. Most patients reporting symptoms of transient ischemic attack should be sent to an emergency department. Patients who arrive at the emergency department within 180 minutes of symptom onset should undergo an expedited history and physical examination, as well as selected laboratory tests, to determine if they are candidates for thrombolytic therapy. Initial testing should include complete blood count with platelet count, prothrombin time, International Normalized Ratio, partial thromboplastin time, and electrolyte and glucose levels. Computed tomographic scanning of the head should be performed immediately to ensure that there is no evidence of brain hemorrhage or mass. A transient ischemic attack can be misdiagnosed as migraine, seizure, peripheral neuropathy, or anxiety.     

Transient ischemic attacks: clinical features, pathophysiology and management

A transient ischemic attack (TIA) is a symptom of underlying vascular disease that requires prompt, accurate diagnosis to prevent its possible complications of stroke, myocardial infarction or death. This article presents the clinical features, pathophysiology, clinical course and management of TIAs. Study of the pathophysiology includes a review of normal physiology of the cerebral vascular system, as well as age-related physiologic changes that put the elderly at increased risk for TIAs. The management plan presented includes reduction of risk factors, patient education, physician referral, and medical and/or surgical treatment. Controversies over medical and surgical treatment are briefly examined.     

Transient ischaemic attacks

Transient ischaemic attacks carry an increased risk of subsequent stroke, but death is more likely to result from myocardial infarction than from cerebral causes. Modification of risk factors, medical treatment and surgical intervention all have a role in management.     

短暂性脑缺血发作的临床分析

目的 :探讨短暂性脑缺血发作 (TIA )的临床表现、发病机理与脑梗死的关系。方法 :对 1994～ 2 0 0 2年所收集的 64例TIA病例的发作特点、影像学及预后进行回顾性分析。结果 :64例TIA病例中有 41例表现为肢体瘫痪 ,眩晕 4例 ,失语 15例 ,精神障碍 2例 ,半侧舞蹈样发作 2例。发作时头颅CT检查发现 3 9例基底节区有腔隙性梗塞灶 ,其余未发现明显的出血及梗塞病灶。64例中有 5 9例痊愈 ,5例发展为脑梗死 ,其中 2例死亡。结论 :TIA与脑梗死的关系密切 ,是脑梗死的特殊缺血半暗带期 ,及时治疗有助于防止大面积脑梗死的发生