Transient ischemic attack

Transient ischemic attack is not a simple and harmless event that can be neglected. It may be a harbinger of an impending stroke. If this important warning sign is overlooked or ignored, the chances of surviving permanent disability or death that may occur in the following days may be lost. The risk of having a stroke within 90 days following the transient ischemic attack is approximately 10%. Approximately half of these cases occur within the first 1-2 days.

Patients with transient ischemic attack should be followed under emergency intensive care conditions. In case of emergency admission in the first hours, thrombolytic therapy should be applied to appropriate patients after detailed clinical and laboratory examinations and evaluations. “Thromboembolic therapy” is the administration of a clot-dissolving drug to the area of ​​the vessel where the obstruction occurs, either through a vein or by using the angiography method. Before applying this treatment, the brain should be examined with computed tomography. The aim of this study is to make a differential diagnosis between stroke due to occlusive vascular disease and stroke due to cerebral hemorrhage, whose clinical and examination findings are very similar. It is absolutely necessary to determine which of these diseases, the treatment of which is completely opposite, is the causative agent. Transient ischemia attacks can be mistakenly interpreted as migraine, seizure, peripheral neuropathy, or anxiety.

Signs of transient ischemic attack include:

– Vision loss: it can be unilateral or bilateral.

– Double vision: defined as double vision or blurred vision.

– Dizziness: rather than feeling something strange at first, the patient feels that he is spinning.

– Difficulty in swallowing: if the difficulty in swallowing is very pronounced, there is a risk of liquid or food escaping into the respiratory tract (aspiration).

– Weakness: unilateral or bilateral arm and / or leg weakness. Facial paralysis may also occur.

– Sensory impairment: seen unilaterally or bilaterally. A numbness or burning sensation is felt in the face, arm, leg, or trunk.

– Speech disorder: difficulty in remembering words, pronouncing or understanding what is being said.

– Coordination disorder: arm, leg or trunk movements are out of balance. The patient may stumble or fall while walking or standing.

– Behavioral disorder: It is seen as the patient’s insensitivity to what is said or incompatible movements.

– Excessive sleepiness can be seen.

– Agitation or psychosis may occur.

There are two main causes of stroke due to vascular occlusion:

– Cardioembolic stroke: In case of irregular functioning of the heart muscles and irregular heart rhythm (arrhythmia, atrial fibrillation), the clot formed in the heart chambers may go to the brain vessels and cause blockage.

– Obstruction due to narrowing or occlusion in the neck or its vessels.

In both cases, their primary treatment is similar due to the occlusion of the cerebral vessel. However, preventive treatment from later attacks differs.

In order to investigate the cause of stroke due to occlusive vascular disease, it is necessary to examine both the heart and the neck and brain vessels.

prof. Dr. Ozenc MINARECI

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