• Principles of drug treatment of transient ischemic attack

    Transient ischemic attack is an acute process of cerebral circulation disturbance, its difference from a stroke is the reversibility of this pathological process. Some neuropathologists call this phenomenon a micro-stroke. If the condition does not change within 24 hours, or irreversible disorders occur, the patient is diagnosed with a stroke.

    How to recognize a transient ischemic attack?

    The main symptoms of transient ischemic attacks appear depending on the area of ​​the brain involved in this process. The blood supply of this organ is carried out through two vascular pools - carotid and vertebrobasilar.

    The carotid pool is formed from two carotid arteries and is responsible for blood circulation of the cerebral hemispheres. As you know, these structures of the central nervous system control the processes related to reading, counting, writing, sensitivity, motor activity.

    The vertebrobasilar pool consists of two vertebral arteries, it feeds the brain stem, which is responsible for the most vital functions - breathing, sight, taste, smell, etc.

    If the violations concern the vertebrobasilar basin, the patient has the following symptoms:

    1. severe dizziness,which does not pass with a change in the position of the body, headache in the occiput, nausea and vomiting;
    2. lack of coordination, accuracy of movements;
    3. tremor of the extremities;
    4. eye movement disorders, strabismus or nystagmus, partial or complete loss of vision;
    5. changes in respiratory movements, arrhythmia of breathing, prolonged pauses between breaths;
    6. memory loss.

    The change in blood flow or its cessation in the carotid basin is accompanied by the following symptoms:

    • paresis and paralysis of various parts of the body;
    • paresis of half of the face with symmetry breaking( in the figure);
    • various changes in speech function( aphasia - lack of understanding of what others say, dysarthria - fuzzy pronunciation of words, or complete absence of speech in the patient);
    • decrease or disappearance of intellectual skills( inability to count, inability to determine the time);
    • violation of reading and writing skills.

    Why does circulatory disturbance occur in the vessels of the brain?

    The causes of transient ischemic attack are the same as when developing a stroke:

    • Progressive atherosclerosis. The deposition of cholesterol plaques narrows the lumen of the vessel, causing a violation of the flow of blood. Sometimes a plaque can come off and with a current of blood gets into a narrower part of the channel, blocking the blood flow completely.
    • No less frequent cause of the development of pathology is thrombosis. Blood clots form in the cavity of the heart muscle with arrhythmia, valvular apparatus defects, infarction, endocarditis.
    • Sometimes a violation of normal blood flow is caused by clamping of the arteries. This occurs with a pronounced cervical osteochondrosis or condition after surgery on the carotid arteries.
    • With a sharp drop in blood pressure, the rate of blood flow in the blood vessels decreases, which causes transient changes( a characteristic symptom in Takayasu's disease).
    • The cause of transient ischemic attack is sometimes pathological processes in the body that contribute to blood thickening( bleeding, angiopathy and coagulopathy), as well as endocrine pathology, which contributes to changes in the structure of the vascular wall( diabetes mellitus).
    • The induction of a micro stroke can be caused by inborn changes in the structure of the brain vessels( hypoplasia or aplasia).

    At risk for this disease are people with excess weight, abusing alcohol and smoking, taking oral contraceptives, leading a sedentary lifestyle!

    What can I do?

    The condition of a patient with such a pathology can turn into a stroke, so the treatment of a transient ischemic attack is performed according to the same scheme as the measures for stroke.

    First of all, the patient needs emergency hospitalization in the intensive care unit. Several patients will observe the patient there: neuropathologist, cardiologist, ophthalmologist, psychotherapist.

    1. Use of thrombolytics. The action of the drugs of this series is aimed at dissolving the thrombus, which blocked the artery. This technique has its negative aspects. For example, it is contraindicated to use if more than three hours have elapsed since the first signs of the transient attack. In addition, a side effect of the use of drugs can be cerebral or gastrointestinal bleeding. Therefore, before the treatment should be done CT of the brain, to exclude hemorrhagic stroke.
    2. Pressure reduction. Hypotensive drugs should not be used on the first day after the patient enters the hospital, as this can worsen his condition.
    3. Optimization of rheological properties of blood. For this purpose, anticoagulants and disaggregants are prescribed. When the blood is thick, intravenous infusions of solutions are indicated.
    4. Neuroprotection and restoration of cell and neuronal metabolism. A patient with a transient ischemic attack is prescribed drugs to accelerate the regeneration and improve the trophic processes of the brain cells.
    5. Normalization of heart rate. In the presence of arrhythmia and conduction disorders, antiarrhythmics are used.

    Transient ischemic attack is a harbinger of a stroke. Therefore, if you have even minor symptoms, you should immediately seek medical help!

    Prevent the danger of

    In order to prevent acute impairment of cerebral circulation, transient ischemic attack and stroke, timely prevention is necessary. It consists in the following recommendations:

    • Food should be complete with sufficient vitamins and trace elements. It should be as much as possible to limit the consumption of food with high cholesterol.
    • Timely treatment of arrhythmia, diabetes, hypertension, thrombophlebitis.
    • Refusal from smoking and alcohol, weight loss.
    • Permanent use of statins( drugs that prevent the formation of sclerotic plaques and reduce the amount of cholesterol in the body).
    • Surgical correction to restore the lumen of the arteries.
    • Reception of means for prevention of formation of blood clots. What can end a transient ischemic attack?

      Emergency hospitalization and adequate treatment in some cases help to cope with neurological disorders, which allows the patient to return to normal life.

      However, the effects of transient ischemic attacks are very severe. If you can not provide full and timely help, the patient develops a stroke with severe neurologic symptoms. The pathological process manifests itself in the form of development of paralysis( of individual limbs or of the whole body), in verbal and cognitive impairments, and can lead to a fatal outcome.

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