Transient ischemic attack

Classification according to ICD-10
G45.8	Other transient cerebral ischemia and related syndromes
G45.9	Transient cerebral ischemia, unspecified
ICD-10 online (WHO version 2019)

A transitory ischemic attack ( TIA ), called striation in Switzerland , is a circulatory disorder in the brain that causes neurological deficits that resolve completely within an hour. In the past, this period was defined as a maximum of 24 hours.

The definition of the TIA is currently subject to an ongoing discussion. The time window of 24 hours is often still mentioned today, for example in the stroke guideline of the German Society for General Medicine and Family Medicine, as of 2012.

If the symptoms do not resolve completely, it is by definition an ischemic stroke (cerebral infarction). The TIA is a typical precursor to a cerebral infarction.

root cause

Using sensitive diagnostic methods, it is now found that many transient ischemic attacks are actually caused by small strokes, especially when symptoms last longer than 30 minutes. This is why the name PRIND (prolonged reversible ischemic neurological deficit) , which was used in the past, is no longer common for an “intermediate stage” between TIA and stroke, since in these cases there is always a “completed” stroke.

The more up-to-date name for a PRIND is the minor stroke (passenger ischemia of the brain with rather slight motor or sensory deficits that regress within 7 days).

The causes of TIA therefore largely correspond to those of a stroke (see there). In addition, TIA also occasionally occur in other diseases, such as migraines (hemiplegic migraines) . In contrast to a stroke, however, the failures in migraines do not occur suddenly and at the same time, but typically one after the other. Often, despite thorough diagnostics, no cause for a TIA is found.

Symptoms

The symptoms of TIA are similar to those of a stroke, particularly typical are paralysis of the arm and / or leg ( hemiplegia or hemiparesis ), speech disorders ( aphasia ), speech disorders ( dysarthria ) and (possibly unilateral) visual disorders ( fleeting blindness ). By definition, a TIA does not take longer than an hour; by then all symptoms have regressed.

The diagnosis of TIA is not only complicated by the short duration of the symptoms, but also by several possible differential diagnoses. Most of the time the symptoms have subsided by the time the patient is admitted to the hospital, and imaging methods cannot provide a clear diagnosis either, whereby MRI with diffusion weighting (50% sensitivity) is the best examination.

therapy

In the acute stage (as long as the symptoms persist), no distinction can be made between a TIA and a stroke. The acute treatment must therefore be based on the stroke approach; In particular, a rapid diagnosis is essential, which should therefore preferably be carried out in a stroke unit .

In the further course (after the symptoms have subsided), particular attention must be paid to the fact that transitory ischemic attacks often appear as a harbinger of a “major” stroke, in 10–30% of those affected it will follow within the next 5 years. This is especially true in the first three days after a TIA, when symptoms last longer than ten minutes and in patients who are older than 60 years. The ABCD2 score can be useful for risk assessment . Patients with paralysis or speech disorders are more at risk than those with visual impairment. Some of the causes of TIA and stroke can be treated with success. So z. B. anticoagulant drugs used for atrial fibrillation or atherosclerosis of the carotid artery . If the blood vessels supplying the brain are severely narrowed , the blood circulation can be improved again with an operation. In patients after TIA, these treatment measures are often particularly useful because if left untreated, they have an increased risk of stroke.

A pilot study in the United States aimed at protecting patients from stroke by inserting a vascular stent after a TIA was discontinued in the 2015 recruitment phase due to a three-fold increased risk of stroke.

literature

• S1 guideline for acute therapy of ischemic stroke of the German Society for Neurology . In: AWMF online (as of 09/2012)
• S3 guideline for primary and secondary prevention of cerebral ischemia of the German Society for Neurology. In: AWMF online (as of 10/2008)
• S3 guideline stroke of the German Society of General Medicine and Family Medicine. In: AWMF online (as of 10/2012)
• S3- guideline secondary prophylaxis of ischemic insult of the German Society for Neurology, as of 09/2012.
• Reinhard Larsen: Anesthesia and intensive medicine in cardiac, thoracic and vascular surgery. (1st edition 1986) 5th edition. Springer, Berlin / Heidelberg / New York et al. 1999, ISBN 3-540-65024-5 , s. 437 f.

Web links

• Carotid stent angioplasty for recurrent TIAs (with film sequences)

Individual evidence

1. ↑ Even with TIA, rapid treatment on the stroke unit is necessary. In: Deutsches Ärzteblatt . May 9, 2016, accessed November 15, 2018 . 
2. ↑ JP Kistler et al .: Initial evaluation and management of transient ischemic attack and minor stroke. In: UpToDate. Version 19.2, May 2011. Full text (fee required)
3. ↑ OO Zaidat, B. Fitzsimmons, B. Woodward et al .: Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis: The VISSIT Randomized Clinical Trial. In: JAMA. 2015; 313 (12), pp. 1240-1248. doi: 10.1001 / jama.2015.1693

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !