TRANSIENT ISCHEMIC ATTACKS (TIA) 暫時性腦缺血
Edited by: Joe Hing Kwok Chu
A stroke is defined as an acute neurological dysfunction of vascular origin with a sudden occurrence of signs and symptoms that correspond with focal areas of the brain. Ten to twenty percent of all strokes are preceded by TIA's. According to the Framingham Study, 12% of cerebral infarcts were preceded by a TIA.
A TIA is a small stroke or local bad circulation in the brain that lasts a short time without cerebral infarction, or a small brain infarction with rapid clinical recovery. TIA's are reversible focal neurological deficits persisting for less than 24 hours but usually the duration is a matter of minutes rather than hours. In a cooperative study, the median duration of carotid TIA's was found to be fourteen minutes and of vertebrobasilar events eight minutes. Ninety per cent of carotid TIA's lasted less than six hours, and ninety per cent of vertebrobasilar TIA's lasted less than two hours.
Both the distinction between a TIA and stroke and the recognition of TIA's are essential for secondary prevention of strokes.
The prognosis for patients with TIA's depends on the presence or absence of associated risk factors.
Risk factors of strokes (summarized by WHO):
Arterial hypertension, diabetes mellitus, heart disease, TIA's and stroke, obesity, platelet hyper-coagulability, excessive alcohol consumption, smoking, elevated lipids, hyperuricemia, infections, genetic factors, and dropping of estrogens level (in female).
Diagnostic Guidelines For Transient Ischemic Attacks
Conditions that can be confused as TIAs or strokes
1. post-epileptic paralysis (Todds's paralysis )
2. low blood sugar (hypoglycemia)
4. conversion disorder (psychological disorder that
causes the physical part of the body to freeze up)
5. brain tumor
6. drug overdose
7. Bell's palsy
8. ear infection
Initial laboratory evaluation of TIA
1. complete blood cell cont with platelet count
2. chemistry profile (including cholesterol and glucose levels)
3. PT and APTT
4. cranial CT (particularly with hemispheric TIA)
5. carotid duplex flow study
7. PET scan
Motor dysfunction: weakness, paralysis, clumsiness of one limb or both limbs on the same side.
Sensory alteration: numbness, loss of sensation, paresthesias involving one or both limbs on the same side.
Speech or language disturbance: difficulty in speaking or writing; incomprehension of language, in reading, or in performing calculations.
Visual disturbances: loss of vision in one eye or part of one eye in a person with previously intact vision; homonymous hemianopsia (loss of half of vision in one or both eyes).
A combination of any of the above.
Note: When sensory motor manifestations occur, they usually appear all at once, that is without a "spread" or "march" effect.
Motor dysfunction similar to above but sometimes changing from side to side in different attacks and varying in degree, from slight loss of voluntary movement to quadriplegia.
Sensory alteration: as above but usually involving one or both sides of the face, mouth, or tongue.
Visual loss: as above but usually involving partial loss of vision in both homonymous fields (bilateral homonymous hemianopia); homonymous hemianopsia.
Disequilibrium of gait or postural disturbance, ataxia, imbalance, or unsteadiness.
Diplopia (double vision), dysphagia (difficulty in swallowing), dysarthria (difficulty in pronunciation), or vertigo.
None of these symptoms alone should be considered evidence of a vertebrobasilar TIA, but any combination of the above can be a cause for concern.
Safe Use of Anticoagulants
Prothrombin Time (PT) is being used to monitor the safe use level of anticoagulants like Aspirin and warfarin (Athrombin-K, Carfin, Coumadin, Panwarfin, Sofarin, Warfilone). Stool analysis for blood is being used to determine if there is internal bleeding.
Qigong and Traditional Chinese Medicine (TCM) diagnostics can be used in conjunction with traditional modern medicine to monitor the risk of thrombosis.
Prevention of Strokes
Life style, eating habits, (including using certain Chinese tonic herbs), exercise, qigong training and qigong therapy are important in preventing strokes and TIA's.
Studies from the Second People Hospital of Shanghai, China show that certain qigong training can decrease strokes, the incidence of mortality from stroke, and post stroke morbidity by 50%. These two studies were conducted over a 20 year period and a 30 year period of time involving 204 patients and 306 patients respectively.
Next Page: Effect of Certain Qigong Practice on Mortality, Stroke and Morbidity of Strokes (Most effective preventive therapy according to a 30 years and a 20 study by the Hypertension Clinic of Shanghai 2nd People Medical School and Hospital).
Samples of Chinese Herb Formulae
Other website on TIA listed for your convenience. We do not guarantee the availability nor the content:
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Last update: Sept 27, 2008; 12:27 p.m. LAH