The transient ischemic attack is a neurological emergency which is a clinical view of focal cerebral, retinal, or spinal dysfunction that lasts less than an hour, without any detectable acute infarction in neurological imaging methods. TIA is a serious warning for ischemic stroke, and this risk is particularly high in the first 48 hours. Following TIAs, approximately 10-15% of patients undergo stroke in 90 days and about half of these patients suffer a stroke in the first two days. Neuroimaging and laboratory studies should be performed quickly to reveal the etiology and to reduce the risk of stroke that may develop in patients present with TIA. Therapeutic and preventive interventions should be started as soon as possible. With early diagnosis and treatment, the risk of a 90-day stroke in these patients can be reduced by 80%. In addition to antiplatelet and anticoagulant treatments, aggressive control of blood pressure, regulation of blood sugar, statin, dietary recommendations, exercise, and managing the other underlying specific conditions should be started quickly.
TopClinical Findings And Risk Factors
TIAs are divided into two main groups as “carotid system” and “vertebrobasilar system” according to the vascular areas reflected by the symptoms. Typical symptoms for TIA include: unilateral face, arm, leg weakness, unilateral sensory loss, dysphasia- aphasia, imbalance, vertigo, diplopia, amaurosis fugax, and rarely hemianopia (Nadarajan, Perry, Johnson, & Werring, 2014). Symptoms such as generalized weakness or generalized sensory loss, confusion, consciousness disorders, syncope, dizziness, incontinence, amnesia, positive symptoms such as involuntary movement, tingling, seeing flashing lights, and bilateral blurred vision are not considered as typical symptoms for TIA (Coutts, 2017).
Pathophysiological mechanisms of TIA are like ischemic stroke. Main mechanisms are transient interruption of a certain artery in the related brain area, differences in cerebral hypoperfusion tolerability, collateral flow, and oxygen-carrying capacity of the patient. This carrying capacity is considered to be low in patients with periventricular and subcortical white matter disease (Leukariosis) (Arsava et al., 2011; Dirnagl, Becker, & Meisel, 2009; Nazliel, 2018 ; Siket & Edlow, 2013).
The main risk factors for the development of TIA include: Age, hypertension (HT), hypercholesterolemia, diabetes mellitus (DM), atrial fibrillation (AF), previous myocardial infarction (MI), carotid artery stenosis, cardiomyopathy, nutritional habits, physical inactivation, smoking, excessive alcohol use and psychosocial stress (Easton et al., 2009; Khare, 2016). Following TIAs, approximately 10-15% of patients undergo stroke in 90 days and about half of these patients suffer a stroke in the first two days (Easton et al., 2009). The risk of having a stroke in the first 24 hours after TIA is approximately 4%. This rate is 2 times the risk of developing MI or death in patients presenting with acute coronary syndrome (2% in 24 hours) (Johnston, Gress, Browner, & Sidney, 2000; Lovett et al., 2003; Nazliel, 2018).