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Transient Ischemic Attacks


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Walid M. Reda Ashour
M.D Neurology, Lecturer of Neurology, Faculty of Medicine, Zagazig University, Egypt
Transient Ischemic Attacks - brain - risk factors

Published in: Health & Medicine
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Transient Ischemic Attacks

  2. 2. TRANSIENT ISCHEMIC ATTACK Definition: Acute, focal neurological deficit with clinical resolution over a period of minutes or up to an hour and which is thought to be due to inadequate cerebral or ocular blood supply as a result of arterial thrombosis , low flow or embolism.
  3. 3. OR brief episode of neurological dysfunction caused by focal disturbance of brain or retinal ischemia, with clinical symptoms typically lasting less than 1 hour and without evidence of infarction. ** Symptoms resolve following rapid fragmentation and dissolution of the microemboli / thrombus.
  4. 4. TIA * Onset sudden & rapid, with complete resolution. * Most TIAs last approximately 2 to 20 minutes. * Initially should involve all affected areas relatively simultaneously. * Should involve focal loss of neurologic function, with symptoms reflecting dysfunction of cerebrum, brainstem, or cerebellum.
  5. 5. Probably NOT TIA * Ill-defined onset, waxes & wanes, or slowly worsens. * Leaves persistent neurologic deficits, however mild. * Neurologic dysfunction of few seconds duration * Episode lasting for more than 1 hour. * Marching of symptoms from one body part to another. * Positive phenomena: involuntary movements, jerking, scintillating scotoma. * Global brain symptoms: giddiness, LOC.
  6. 6. The symptoms start more or less abruptly, and they are ‘focal’, indicating a disturbance in a particular area of brain, or in one eye. Motor symptoms (the most common): * Weakness, * Clumsiness or * Heaviness. in the upper limb or lower limb or face alone, or in various combinations, usually on just one side of the body. sensory symptoms: * Numbness or * Tingling.
  7. 7. Transient monocular blindness (amaurosis fugax): Affects the upper or lower half of vision, or all the vision of one eye, and is often described like a blind or shutter coming down from above, or up from below. Indeed, if a patient still has symptoms more than an hour after the onset, the chances are that they will persist for more than 24 hours and so the patient will actually have had a stroke
  8. 8. N.B. Vertigo, diplopia, dysphagia, unsteadiness, tinnitus, amnesia, drop attacks, and possibly dysarthria are so often due to global cerebral ischaemia, or non-vascular causes, that if one occurs as an single symptom the diagnosis of TIA is very uncertain
  9. 9. ** In the clinical analysis of TIAs, it is important to separate a single transient episode from repeated ones that are all of uniform type. The latter are more a warning of impending vascular occlusion, particularly of the internal carotid artery, whereas the former, especially when prolonged, are again often caused by an embolus that leaves no lasting clinical effect.
  10. 10. TIAs can reflect the involvement of virtually any cerebral artery: common or internal carotid; middle, posterior, or anterior cerebral; ophthalmic; vertebral, basilar, or cerebellar; or a penetrating branch. The carotid (80 %) or vertebrobasilar vascular territories (20 %). TIAs may precede, accompany, or infrequently follow the development of a stroke, or they can occur by themselves without leading to a stroke.
  11. 11. About two thirds of all patients with TIAs are men with hypertension, reflecting the higher incidence of atherosclerosis in this group. Occasionally, in younger adults, TIAs may occur as relatively benign phenomena, without recognizable features of atherosclerosis or risk factors for it.
  12. 12. Differential diagnosis
  13. 13. Approximately 20 % of infarcts that follow TIAs occur within a month after the first attack, and approximately 50 percent within a year.
  14. 14. CAUSES OF TRANSIENT FOCAL NEUROLOGICAL ATTACKS 1-Focal cerebral ischaemia (i.e. TIA) 2- Migraine with aura 3- Partial epileptic seizures 4- Structural intracranial lesions Tumour Chronic subdural haematoma Vascular malformation Giant aneurysm 5- Multiple sclerosis 6- Labyrinthine disorders (e.g. Meniere's disease, benign positional vertigo) 7- Peripheral nerve or root lesion 8- Metabolic: Hypoglycaemia Hyperglycaemia Hypercalcaemia Hyponatraemia 9- Psychological
  15. 15. Migrainous auras come on slowly, spread and intensify over several minutes, and fade in 20–30 min. The symptoms tend to begin in one domain (particularly vision), fade and move on to another. Also symptoms tend to be positive (e.g. flashing lights, tingling) rather than the typically negative symptoms of a TIA (e.g. weakness, visual loss, numbness).
  16. 16. Partial epileptic seizures The symptoms ‘march’ across a hand or foot, and up the limb in a minute or so and may, eventually, be accompanied by focal motor seizures or secondary generalization. Sudden speech arrest seems to be more often epileptic than due to ischaemia, which is more likely to cause dysphasic
  17. 17. Thank you