A transient ischemic attack, while not causing permanent brain damage, should never be overlooked; in fact, it could be the first indication of a predisposition to stroke, the outcome of which can be lethal.
Through a "careful diagnosis, it is possible to trace the vascular anomaly that caused the TIA and, on the basis of this, set the therapy; therapy, which can be both pharmacological and surgical.
The prevention of risk factors and careful lifestyle care are essential to avoid worsening the situation and the onset of a stroke.
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Figure: transient ischemic attack is a particular form of ischemic stroke. Obstruction, due to a blood clot, can occur in a cerebral artery, but also in the carotids. From the site: fibrillazioneatriale.it
Stroke is defined as ischemic if at the origin of the disorder there is an obstacle inside the cerebral arterial vessels, which prevents the normal circulation of the tissues of the brain. This obstacle can be represented by a mobile blood clot (embolus) or anchored to the vessel wall (thrombus).
The thrombus, very often, originates in the heart; the thrombus, on the other hand, can form in an arterial vessel of the brain, in a carotid artery or in a vertebral artery, after the rupture of an atherosclerotic plaque.
EPIDEMIOLOGY
It is difficult to provide precise data on the real incidence of TIA, since, being a transient event, the patient, in some cases, does not care and the disorder goes unnoticed.
The annual incidence is therefore vague and the calculated value, for Italy, is around one case for every 1,000 inhabitants (about 60,000 episodes, if we consider the entire population).
Since TIA is a particular form of stroke, it shares several epidemiological aspects with it. Like stroke, in fact, TIA affects the most:
- Older people (75% of affected individuals are over 65)
- More men than women, especially before reaching old age
- Individuals of African, Asian and Caribbean ethnicity, due to a predisposition of these ethnic groups to diabetes and heart disease
People affected by TIA are more likely to develop similar episodes, or even an actual stroke, in the future. In fact, it seems that about one in 5 stroke cases is preceded by a TIA episode.
, is related to the presence of a blood clot (thrombus or embolus) which occludes one of the cerebral arterial vessels. In these conditions, the brain cells, no longer properly perfused, find themselves without oxygen and nourishment and, for this reason, enter a state of suffering that can be lethal.
Further reading: Why do thrombi and emboli form?
A thrombus is a solid occlusive mass that is generated inside a blood vessel after the lesion of an atherosclerotic plaque. The latter is a collection of fat cells and cholesterol, which forms on the inner wall of a vessel spontaneously or due to certain pathological conditions (see risk factors).
The presence of a plaque hardens the vessel wall and this predisposes it to ruptures and injuries. After an injury, repairing cells are called up, the platelets, which, combined with cholesterol, give rise to the actual thrombus.
An embolus, on the other hand, is a mobile blood clot that was originally part of a thrombus from which it has detached. Often, the emboli that cause a TIA come from a heart that is not in perfect health.
THE RISK FACTORS
The risk factors for transient ischemic attack are numerous and deserve special attention. In fact, knowing the conditions that favor the onset of a TIA is fundamental for both prevention and treatment.
In general, two categories of risk factors can be recognized: those that are potentially treatable and those that cannot be treated.
By potentially treatable risk factors we mean all those circumstances for which there is a remedy, pharmacological or behavioral. For example, diabetes (one of the main risk factors for stroke) can be treated either with hypoglycemic drugs or by adopting a healthy lifestyle (diet low in fat and simple sugars and exercise).
By non-treatable risk factors, on the other hand, we mean certain characteristics of the patient that cannot be changed, such as age, ethnicity, etc.
Treatable risk factors:
- Hypertension
- Cardiovascular disease (or heart disease)
- Diseases of the carotid artery
- Smoking and passive smoking
- Physical inactivity
- Diabetes
- Obesity and overweight
- High cholesterol
- Birth control pill and hormone therapy (estrogen based)
- Excess of alcohol
- Drug use (cocaine and methamphetamines)
- Elevated levels of homocysteine in the blood
The untreatable risk factors:
- Family history of TIA, stroke and heart attack
- Age over 55-60 years
- Sex. TIA is more common in males than females
- Ethnicity. The most affected populations are those of Asia, Africa and the Caribbean.
- Sickle cell anemia. Red blood cells, due to their particular shape, tend to form agglomerates that clog blood vessels
Knowing what the classic symptoms and signs of a TIA are is essential for recognizing the disorder if it occurs.
In fact, in some cases, the TIA can go unnoticed or in any case be taken lightly by the patient, since it is a transitory and reversible situation. However, as we have seen, it should always be borne in mind that at least one in five stroke individuals have had a TIA before. The transient ischemic attack, therefore, can be considered a real alarm bell.
THE SYMPTOMS
The symptoms of TIA are reminiscent of those of a stroke and, as such, are not always the same; much depends on the area of the brain involved in the disorder, as different regions of the brain govern different areas of our body. This means, therefore, that each patient, suffering from a transient ischemic attack, represents a case in itself. The classic signs and symptoms are:
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If you experience similar symptoms, call 118 immediately. From the irish heart condition awareness campaign.
- Paralysis and a feeling of numbness in the face and limbs
Features: these disorders, also associated with tingling and weakness, occur on one side of the body only (for example, they affect either the left-sided limbs only or the right-sided limbs only).
To recognize the sign: raise your arms above your head or in front of you, and see which of the two tends to fall without our will; or smile (in front of a mirror) and observe which corner of the mouth slowly returns to its normal position. - Difficulty speaking and understanding
Features: the patient speaks in a stammering and unclear way; cannot understand what others are saying. - Difficulty walking and balance
Features: the patient suddenly begins to stumble, suffer from vertigo and lose balance and motor coordination. - Visual difficulties
Features: the patient, always suddenly, begins to lose his visual abilities. The vision, in fact, becomes blurred or blurred. The disturbance can affect one or both eyes.
WHY IS THE TIA TEMPORARY? HOW LONG DOES IT LAST?
Transient ischemic attack differs from stroke only in the temporary and reversible nature of its symptoms. For the rest, there are no other differences.
But how can this temporariness be explained? The blood clot, either thrombus or thrombus, creates a transient obstruction. On the contrary, in ischemic stroke, the blood clot blocks the affected vessel permanently.
An episode of TIA usually lasts from a few minutes to an "hour, and there are rare cases in which the disorder lasts longer. If it exceeds 24 hours, it is not classified as a TIA but as a stroke.
To understand that the TIA is exhausted, we obviously rely on the symptoms, which disappear.
WHEN TO SEE THE DOCTOR?
Since stroke and TIA share the same symptomatology, it is not possible to distinguish one from the other, except because the transient ischemic attack, at some point, ends spontaneously. However, wait to see the evolution of the situation is not a smart choice! In fact, it would mean taking a big risk, as it could have dramatic implications. As typical symptoms occur, immediate medical attention should therefore be sought.
At this point, only the doctor's opinion and diagnostic tests will make it clearer.
COMPLICATIONS
The TIA wears off on its own, leaving no complications or permanent marks on the affected individual. Therefore, talking about TIA complications is inappropriate. However, reiterating the concept that a TIA often anticipates a stroke, it is possible to define the latter, that is, the stroke, the only real complication.
Stroke requires immediate help (the risk of death is high), the administration of adequate drugs, surgery, long rehabilitation (physical and psychological) and the correction of an incorrect lifestyle (if this is one of the causes of the disorder).
CONTINUES: Diagnosis, Treatment, Prevention
