Suddenly my hands and feet were weak, I couldn't speak, and my face was crooked. The family suspected a stroke and rushed to the hospital. However, in the emergency department, these symptoms disappeared again. Brain CT and magnetic resonance examination showed no cerebral hemorrhage or cerebral infarction. There was nothing wrong with this examination, but it looked like a stroke at the time. Later, the doctor told me that it might be a transient ischemic attack, which puzzled my family. What is a transient ischemic attack? Why does it look like a stroke?

What is a transient ischemic attack?

Transient ischemic attack, also known as TIA, is commonly known as "pawn". It is a transient neurological dysfunction caused by focal ischemia of brain, spinal cord or retina without acute cerebral infarction, which is characterized by transient aphasia, hemiplegia, limb numbness and dizziness. Unlike acute cerebral infarction, most TIA symptoms are relieved after 5- 10 minutes, usually less than 1 hour. Imaging examination will not leave any imaging evidence of cerebral infarction. Traditionally, transient ischemic attacks last less than 24 hours.

Why did TIA happen?

TIA attacks are often caused by emboli falling off after cerebral atherosclerotic plaque rupture or cardiogenic microemboli (common in atrial fibrillation) falling off. The embolus flows into the brain with the blood, and after embolizing a blood vessel, symptoms such as hemiplegia and aphasia suddenly appear. When the embolus moves to the distal end or dissolves itself, the nerve function recovers and there is no pathological change in histology. There are also some hemodynamic disorders caused by arteriolar stenosis or vasospasm, such as the decrease of blood pressure fluctuation and cardiac output, which leads to the decrease of blood flow at the distal end of stenosis and further leads to brain dysfunction.

Who is prone to transient ischemic attack?

The risk factors of TIA and cerebral infarction are the same, including hypertension, diabetes, hyperlipidemia, smoking, alcoholism, obesity and family history. Men are more common. After the age of 45, with the increase of age, the risk of TIA and cerebral infarction gradually increases.

What are the hazards of TIA?

The risk of cerebral infarction in any TIA patient is significantly increased. Cerebral infarction is the disease with the highest disability rate. Its high disability rate, high recurrence rate and high mortality rate bring heavy burden and great pain to society, families and patients. Therefore, TIA is a dangerous signal of cerebral infarction and should be paid enough attention to. Once a transient ischemic attack occurs, you must go to the hospital immediately.

The early symptoms of TIA and cerebral infarction are also very similar, which can only be distinguished by brain magnetic resonance imaging or with the passage of time. Although the symptoms of TIA can return to normal on their own, they cannot be ignored. Because the risk of recurrence or cerebral infarction in patients with TIA is very high, the risk of cerebral infarction in patients with TIA within the second, seventh, thirtieth and ninety days after onset is 3.5%, 5.2%, 8.0% and 9.2% respectively. Therefore, once TIA is suspected, it is necessary to see a doctor, find out the cause, and carry out appropriate medical or surgical treatment to prevent acute cerebral infarction in the future.

How to identify TIA?

Transient ischemic attack has many clinical manifestations. Different patients have different clinical manifestations after onset. Patients may have hemiplegia, aphasia and numbness of limbs, as well as dizziness, nausea and vomiting. This is mainly related to the different positions of ischemic blood vessels and brain tissue in patients.

The blood supply of the brain is responsible for two vascular systems: one is the internal carotid artery system and the other is the vertebrobasilar artery system. According to the damaged blood supply system and brain tissue, the symptoms of TIA vary greatly.

The internal carotid artery system supplies blood to the first two-thirds of our brain, and its blood supply is mainly divided into two parts, one is the middle cerebral artery and the other is the anterior cerebral artery. There is something wrong with this system. The patient may have a short-term clumsiness or weakness in one limb, a short-term numbness in one limb and a crooked face. Transient monocular blindness and blurred vision may occur; There may also be a brief lisp and even inability to speak.

The vertebrobasilar artery system is mainly responsible for the blood supply behind our brain 1/3 (including brain stem and cerebellum). If the vertebrobasilar artery system is involved, the most common symptoms are dizziness, nausea and vomiting, and some patients will be accompanied by tinnitus. Patients may also have visual impairment, visual field defect or diplopia, that is, diplopia. If the basilar artery segment is involved, the patient may suddenly lose consciousness. If the medulla oblongata segment of the brain stem is involved, the patient may suddenly become hoarse or unable to make a sound, and some may be accompanied by dysphagia and choking in drinking water. If the reticular structure of brain stem is involved, the patient will have a fall attack. When a fall occurs, most patients can suddenly fall to the ground when turning their heads or looking up, but there will be no disturbance of consciousness, and they can stand up on their own after the fall, and there will be no limb weakness afterwards. Patients can also have short-term complete amnesia, and patients may suddenly have amnesia for a short time, but they can know the time and place at that time.

What should I do after transient ischemic attack?

Once you suspect TIA, you should call 120 immediately and go to a hospital with the qualification of stroke center. The doctor will make a diagnosis of TIA on the basis of inquiring about medical history, physical examination and other auxiliary examinations, combined with the risk factors of stroke. Once TIA is diagnosed, it is necessary to find the cause and prevent recurrence.

First of all, after excluding cerebral hemorrhage, it is recommended to take antiplatelet aggregation drugs, such as aspirin and clopidogrel, for patients with non-cardiogenic TIA. For patients with cardiogenic TIA (accompanied by atrial fibrillation, rheumatic mitral stenosis, artificial heart valve implantation, etc. ), it is recommended to take anticoagulants such as warfarin orally. If carotid artery stenosis is found, surgery may be needed.

The second is to control risk factors such as hypertension, diabetes and hyperlipidemia.

How to prevent TIA?

For people who have never had a transient ischemic attack, the key to prevention is to eliminate the potential risk factors or minimize them. Such as controlling hypertension, diabetes, hyperlipidemia, quitting smoking and losing weight through diet, physical exercise or medication.

Finally, I hope everyone can pay attention to it, pay attention to health and stay away from these high-risk factors.

Expert business card

Nie zhiyu

Tongji hospital affiliated to Tongji University

Chief physician, professor and doctoral supervisor of neurology.

Expert clinic: Thursday morning

Special needs clinic: Monday afternoon

Areas of expertise: first aid, standardized diagnosis and secondary prevention of cerebrovascular diseases; Diagnosis and treatment of Parkinson's disease; Epilepsy; Headache; Nervous system diseases such as facial paralysis.

He is currently the executive director of the Department of Neurology, tongji hospital, affiliated to Tongji University. He is also a member of Chinese Preventive Medicine Association's Stroke Prevention Committee, Shanghai Medical Association's Stroke Branch, China Gerontology Society's Cardiovascular and Cerebrovascular Diseases Committee, Shanghai Neurology Branch's Cerebrovascular Diseases Group, Shanghai Society of Integrated Traditional Chinese and Western Medicine's Fifth Neurology Committee, and Shanghai Society of Integrated Traditional Chinese and Western Medicine's First Professional Committee Standing Committee. Standing Committee member of the 4th Neurorehabilitation Professional Committee of Shanghai Rehabilitation Medical Association, member of Cardiovascular and Cerebrovascular Diseases Group of China First Aid Branch, member of the 6th World Stroke Congress (WSC), member of the Cerebrovascular Diseases Group of Shanghai Neurology Branch, member of the 1st Committee of Neurology Professional Committee of Bethune Medical Expert Committee, member of the 1st Committee of Neurology Branch of Shanghai Medical Doctor Association, member of the 2nd Committee of Neurology Experts of China Medical Doctor Association, editor of China Geriatric Cardiovascular and Cerebrovascular Diseases Journal, and China Stroke Journal.

Since my work, I have presided over more than one project 10, including the general project of the National Natural Science Foundation, the project of Shanghai Science and Technology Commission, the project of Liaoning Education Commission, the project of Shanghai Health Bureau, etc., and published more than 20 papers and edited 6 books 16. I have been engaged in medical treatment, teaching and scientific research for 30 years in the neurology department of 3A hospitals, and have accumulated rich experience in treating intractable diseases and critically ill patients. I have successfully diagnosed and rescued a number of patients with severe stroke, Guillain-Barre syndrome, myasthenia gravis, cerebral venous sinus thrombosis and other diseases, and made a clear diagnosis for patients with diabetic ophthalmoplegia, lateral femoral cutaneous neuritis and special types of myasthenia gravis who have been running around many hospitals, thus relieving their troubles.

Text | Neurology Department

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