Transient cerebral ischemia

Introduction The symptoms of transient ischemic attack are similar to those of cerebral thrombosis, but they are not serious. Generally, they do not recover completely within 24 hours, and there is no sequelae. Some people call it a small stroke. Its true meaning is that a temporary blood circulation disorder (temporary interruption or significant reduction in blood supply) in a certain area of the brain causes a transient, recurrent cerebral ischemic neurological symptom with rapid attack, short time, quick recovery, etc. Characteristics, therefore also known as transient ischemic attack or transient focal cerebral ischemia.

Cause

There are many causes of transient cerebral ischemia, but it is generally recognized that the most common cause of atherosclerosis in the brain and extracranial.

Its pathogenesis has not yet been fully elucidated, and it can be related to cerebral artery occlusion, cerebral artery atherosclerotic plaque stains, and thrombus fragments on the blood vessel wall. Because the embolus is small or easily broken into smaller pieces and moved forward to a finer artery, or even completely disappeared, the blood flow in the brain tissue is re-established, and the symptoms of cerebral ischemia quickly disappear. Other hemodynamic changes such as sudden drop in blood pressure and cervical bone hyperplasia and compression of blood vessels, when the patient turns his head, can cause high vertebral-basal artery ischemia, vertigo and other ischemic symptoms, when the position of the head and neck turns positive, blood circulation After recovery, the symptoms of vertigo disappear. All of the above statements have certain basis, but under different conditions, the pathogenesis of the disease is also different, such as cerebral vasospasm when blood pressure is high, hemodynamic factors are mainly when blood pressure is low, and microembolism is mostly internal carotid artery system. Transient cerebral ischemia is the main cause and so on. Transient cerebral ischemia is often associated with reconstitution of the cerebral collateral circulation, and if the collateral circulation is poor, it can develop into a complete stroke.

(1) Atherosclerosis, which supplies cerebral blood circulation, is the most common cause of transient ischemic attacks. The most common is the formation of carotid atherosclerotic thrombosis, often leading to stenosis of the lumen, resulting in reduced blood flow to the supply of the brain.

(2) Arterial-arterial thromboembolism: The embolus originates from the ulcer surface of the atherosclerotic plaque of the carotid or vertebral artery of the neck, or less from the wall thrombus in the heart; the most common cardiac embolus The causes are atrial fibrillation, valvular disease, and left ventricular thrombosis.

(3) Less common causes: 1 dissection of aneurysm, arteritis and abnormal blood components (such as polycythemia vera, thrombocytopenia, anti-cardiolipin antibody syndrome, etc.); 2 hemodynamic changes: short-lived blood flow Reduce hypotension, arrhythmia, subclavian steal syndrome, and adverse drug reactions for any reason; 3 complications of cardiac intervention and surgery; 4 hypertension, atherosclerosis, heart disease, diabetes, and Hemocytosis is prone to a transient ischemic attack.

an examination

Related inspection

Brain CT examination cerebral blood flow measurement tomography cerebral blood flow perfusion tomography

The symptoms of transient ischemic attack are many, related to the site of ischemia, usually divided into the carotid system vertebral-basal artery system. Transient ischemic attack of the carotid artery is often seen in one limb or single limb palsy, weakness, or numbness of hands and feet, acupuncture, lack of movement, difficulty speaking or not speaking at all, blurred vision or blindness of one eye, Dizziness, headache and disturbance of consciousness. The transient ischemic attack of the vertebral-basal artery system is characterized by sudden dizziness, nausea, vomiting, visual rotation, visual impairment, hearing loss, etc., somewhat like Meniere's syndrome; some are hoarseness, swallowing Difficulties or wrinkles when drinking water; in severe cases, sudden loss of consciousness and quenching, this one of the most important forms of vertebral-basal artery insufficiency, neither aura before the fall, but also quickly recovered, so the fall of the collapse Prevention should be strengthened to prevent the danger of recurrence.

Differential diagnosis

Cerebral ischemia is easily misdiagnosed as cervical spondylosis: recent clinical findings have shown that many patients with cerebral ischemia are misdiagnosed as cervical spondylosis because of the similar clinical symptoms of vertebral-basal artery ischemia and cervical spondylosis. Experts pointed out that only by understanding the difference between the two diseases can they be effectively screened. Generally, when cervical spondylosis occurs, vertigo often occurs in the neck. When the doctor visits, the doctor usually performs cervical imaging examination for the patient. Only when there is bone hyperplasia at the transverse process of the cervical vertebrae, and it is pressed to the vertebral artery, can it be judged to be dizziness caused by cervical spondylosis, otherwise it may be vertigo caused by the lesion of the vertebral-basal artery itself. The vertebral-basal artery ischemia is mostly caused by intravascular obstruction and does not necessarily occur during neck activity.

The symptoms of transient ischemic attack are many, related to the site of ischemia, usually divided into the carotid system vertebral-basal artery system. Transient ischemic attack of the carotid artery is often seen in one limb or single limb palsy, weakness, or numbness of hands and feet, acupuncture, lack of movement, difficulty speaking or not speaking at all, blurred vision or blindness of one eye, Dizziness, headache and disturbance of consciousness. The transient ischemic attack of the vertebral-basal artery system is characterized by sudden dizziness, nausea, vomiting, visual rotation, visual impairment, hearing loss, etc., somewhat like Meniere's syndrome; some are hoarseness, swallowing Difficulties or wrinkles when drinking water; in severe cases, sudden loss of consciousness and quenching, this one of the most important forms of vertebral-basal artery insufficiency, neither aura before the fall, but also quickly recovered, so the fall of the collapse Prevention should be strengthened to prevent the danger of recurrence.

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