From this article you will learn: what is the pre-stroke state( or, in other words, transient ischemic attack), the reasons for its development. Symptoms, methods of diagnosis and treatment of this disease.
Background of the article:
- Preinvasive condition reasons
- Pre-absent state risk factors
- Symptoms of the disease
- Diagnosis of the pre-sultural state
- Treatment of the disease
- Pre-abscess forecasting
An initial condition of the brain is the deterioration of the blood supply to the brain. Doctors call it a transient ischemic attack( abbreviated TIA).TIA in its symptoms is similar to a stroke, however its clinical picture is short-lived, as the cerebral blood flow after deterioration is quickly restored. Symptoms of pre-stroke state last no more than 24 hours.
Although TIA does not cause permanent damage to the brain tissue, its appearance is a dangerous sign of the possibility of developing a full-fledged stroke in the future, which occurs in about a third of these patients.
Therefore, in such cases it is necessary to consult a neurologist. Correctly prescribed treatment in many patients can reduce the risk or prevent the development of a stroke.
Reasons for the pre-absent state of
TIA develops when blood flow is disturbed along one of the arteries supplying the brain with oxygen-rich blood. This deterioration of blood flow leads to the fact that the brain can not function normally, causing symptoms and signs of pre-sultural state.
With the pre-absent state, this blood supply disorder goes away quickly, and the delivery of blood to the brain returns to normal before a serious damage to the brain tissue occurs.
Overlapping the arteries responsible for the development of most cases of TIA is usually caused by the formation of a thrombus in other parts of the body, which is transferred to the blood vessels of the brain and blocks them.
The most frequent place of formation of these small thrombi are atherosclerotic plaques( atheromas) in the carotid and vertebral arteries that supply blood to the brain. A thrombus that detached from an atheroma or a part of it is transferred to the brain and gets stuck in an artery of small diameter, blocking its lumen.
Click on the picture to enlarge Sometimes small blood clots form in the heart cavity. This most often occurs in the presence of atrial fibrillation - a disease in which the heart shrinks irregularly.
Small clots stuck in the brain vessels can quickly resolve, so that with TIA, permanent damage to the nervous tissue does not develop, and the symptoms go away.
Sometimes TIA can also be caused by:
- problems with blood clotting;
- with small hemorrhages in the brain;
- with blood diseases, such as polycythemia and sickle cell anemia, in which it becomes very dense;
- spasm of small arteries in the brain.
Pre-stroke risk factors
Certain factors may increase the risk of developing TIA.The main of them are:
- Age - although the pre-stroke condition can occur at any age( including even children), it is much more common in people older than 60 years.
- Medical history - TIA is more common in patients with hypertension, atrial fibrillation, diabetes mellitus and elevated blood cholesterol.
- Overweight and obesity.
- Diet - the risk of the disease is higher in people whose diet contains a lot of salt and fat.
- Smoking and alcohol abuse.
Having eliminated some of these factors, you can reduce the risk of developing TIA and stroke.
Symptoms of the disease
Symptoms of TIA are the same as in stroke, but differ in duration, which can be several minutes or hours.
Symptoms of pre-stroke state appear suddenly. The main ones can be remembered according to the mnemonic rule - the FAST word, in which:
- F - FACE( face).A person can become down on one side, a person can not smile, his mouth twists.
- A - ARM( arm).A person with suspected TIA or a stroke may not be able to raise both hands and hold them in the raised position due to weakness.
- S-SPEECH( speech).The speech may be vague or distorted, some patients generally can not speak.
- T - TIME( time).If any of these symptoms are found, emergency medical attention should be called immediately.
It is important for every person to know about these symptoms and signs of a pre-stroke condition, especially for people living with elderly people who have diabetes or hypertension.
Other signs of pre-sultness include:
- weakness in one half of the body;
- sudden vision impairment;
- dizziness;
- headache;
- impaired consciousness;
- problems with a sense of balance and coordination of movements;
- difficulty with swallowing.
Pre-emergence symptoms are not gender-dependent, they are the same for both men and women.
The severity of the clinical picture of TIA may be different, depending on the caliber and location of the sealed vessel. Some people have symptoms that go away quickly and do not interfere with daily activities, while in others they make any kind of everyday activities almost impossible. Regardless of the duration and severity of the clinical picture, all people with the symptoms described above should immediately consult a doctor, since it is impossible to distinguish TIA from a stroke in the early stages. Even if the symptoms have disappeared during waiting ambulance, hospitalization is needed in the hospital for detailed examination and treatment.
Diagnostics of the pre-stroke state of
It is very important that a person with characteristic symptoms get on the examination to a doctor as soon as possible, since he can have a full stroke. In some patients at the time of neurologic examination, the clinical picture of TIA may no longer be present.
Doctors may prescribe several examinations that confirm the presence of a pre-stroke condition and identify its possible causes:
- Blood pressure measurement.
- Blood tests for glucose and cholesterol.
- Electrocardiography - the pre-sultural state can develop with atrial fibrillation, which is detected by ECG.
- Ultrasound examination of carotid arteries - can detect narrowing or overlap of these vessels on the neck.
- Computer or magnetic resonance imaging - using these methods, you can get images of the brain.
Treatment of
Although symptoms of TIA occur within a few minutes or hours without any specific treatment, patients with pre-impaired conditions need medical care to prevent stroke in the future.
Treatment may include:
- reduction of risk factors available to the patient;
- medications that reduce the risk of blood clots;
- surgical interventions.
1. Reduction of risk factors available to the patient
To reduce the risk of stroke, a person needs to change his life. These changes may include:
- Healthy eating - it is recommended that a diet with a low content of fat and salt, rich in fiber, fresh fruits and vegetables is recommended.
- Regular exercise - every person is recommended at least 150 minutes of aerobic exercise of moderate intensity, such as brisk walking or cycling.
- Weight normalization.
- Cessation of smoking.
- Restriction of the use of alcoholic beverages.
These same tips for lifestyle modification, together with careful treatment of hypertension, cardiac rhythm disturbances and diabetes mellitus, are at the heart of pre-stroke prevention.
2. Drugs that reduce the risk of blood clots
In addition to these changes in lifestyle, most patients with TIA need to take certain medications daily that reduce the risk of stroke. These include:
- Antiaggregants( antiplatelet drugs) are drugs that reduce the ability of platelets to form clots. Immediately after the occurrence of pre-sultness, doctors prescribe aspirin or clopidogrel to the patient.
- Anticoagulants are drugs that prevent the formation of thrombi by reducing the level of coagulation factors in the blood. These drugs are warfarin, rivaroxaban and dabigatran. Most often, anticoagulants are prescribed for those patients in whom TIA is due to the formation of thrombi in the heart cavity, which most often occurs in the presence of atrial fibrillation.
If a person has a pre-sultural condition, he must carefully monitor diseases such as hypertension, diabetes, atrial fibrillation, following the recommendations of doctors on their drug treatment.
3. Surgical interventions
Approximately 5% of patients with TIA have a pronounced carotid artery constriction with an atherosclerotic plaque. They may need a carotid endarterectomy operation.
Carotid endarterectomy is a surgical procedure during which surgeons remove part of the inner carotid shell with atheroma. Thanks to this operation, it is possible to significantly reduce the risk of stroke in these patients.
Prognosis for pre-adult status
The TIA does not cause permanent damage to the brain. However, its presence indicates that this patient has a high risk of developing a stroke in the future.
If treatment of TIA is not performed, within a year the stroke develops in about 10-20% of patients. The greatest danger is observed during the first month after the pre-stroke state. During treatment, this risk is reduced by about 80%.
