Anwer U E
University of Massachusetts Medical Center, Memorial Health Care, Worcester 01605, USA.
Eur Neurol. 1998;39 Suppl 1:17-20. doi: 10.1159/000052065.
Transient ischemic attacks (TIAs) are warning episodes predicting that such patients are at high risk for stroke which potentially could be life-threatening or leave an individual with substantial disability. TIAs result from large or small vessel disease, cardiogenic embolic events and hematological abnormalities. The patient's past and current medical history provides necessary clues suggesting which investigational tests should be conducted. Every patient presenting with a TIA should have a total blood count, electrocardiogram, and a brain imaging study. Patients with anterior circulation symptoms should undergo noninvasive carotid testing, usually by carotid duplex ultrasonography, to determine if there is a surgically remediable carotid stenosis. Patients with posterior circulation TIAs should undergo magnetic resonance angiography (MRA) or a conventional arteriogram which, if positive, may be an indication for anti-platelet or anticoagulation therapy. Other testing depends on the presumptive etiology of the TIA. In general, a TIA should be considered as a serious warning of impending stroke that requires rapid and efficient investigations to define and remedy the reasons for the cerebral ischemic events. TIAs by definition may last up to 24 h, but usually are self-terminating after a few minutes. They are a serious warning of possible future strokes that may result in substantial morbidity and mortality. Once TIAs are diagnosed, the major goal is to reduce the risk of future strokes. Patients with TIAs usually present in the Emergency Room or doctor's office. They may seek immediate medical care or relate the history of the TIA during a routine visit. As soon as a diagnosis of a TIA is considered, a careful past and current medical history should be taken to substantiate the diagnosis. Conditions which mimic TIAs need to enter into the differential diagnosis and, if necessary, be ruled out. For example, a Todd's transient paralysis can follow a partial focal seizure. Migraine auras may also mimic TIAs, particularly in the elderly. Any space-occupying lesions and arteriovenous malfunction may first present with a TIA-like complaint. Peripheral nerve disease must be recognized since it can cause transient weakness and/or numbness affecting one limb.
短暂性脑缺血发作（TIA）是一种预警事件，提示此类患者有发生中风的高风险，中风可能危及生命或导致患者严重残疾。TIA 由大血管或小血管疾病、心源性栓塞事件及血液学异常引起。患者的既往病史和当前病史为应进行哪些检查提供了必要线索。每位出现 TIA 的患者都应进行全血细胞计数、心电图和脑部影像学检查。有前循环症状的患者应接受无创颈动脉检查，通常采用颈动脉双功超声检查，以确定是否存在可通过手术治疗的颈动脉狭窄。有后循环 TIA 的患者应接受磁共振血管造影（MRA）或传统动脉造影，如果检查结果呈阳性，可能提示需要进行抗血小板或抗凝治疗。其他检查取决于 TIA 的推测病因。一般来说，TIA 应被视为即将发生中风的严重预警，需要迅速而有效地进行检查，以明确并纠正脑缺血事件的原因。根据定义，TIA 可持续长达 24 小时，但通常在几分钟后自行终止。它们是未来可能发生中风的严重预警，可能导致严重的发病率和死亡率。一旦诊断为 TIA，主要目标是降低未来中风的风险。TIA 患者通常在急诊室或医生办公室就诊。他们可能会立即寻求医疗护理，或在常规就诊时讲述 TIA 的病史。一旦考虑诊断为 TIA，应仔细询问既往病史和当前病史以证实诊断。需要鉴别诊断并在必要时排除那些类似 TIA 的病症。例如，托德氏短暂性瘫痪可在部分局灶性癫痫发作后出现。偏头痛先兆也可能类似 TIA，尤其是在老年人中。任何占位性病变和动静脉功能障碍最初可能表现为类似 TIA 的症状。必须识别周围神经疾病，因为它可导致影响一个肢体的短暂性无力和/或麻木。
