Clinical Analysis Of 148 Patients With Transient Ischemic Attack

Objective and Method: People pay more and more attention tothe duration problem of the transient ischemic attack, we had qualifiedthe longest duration been 24 hours. We found that the traditionalconcept of transient ischemic attack was not precise, through a largeamount of clinical observation and the comprehensive application ofthe transcranial Doppler, computed tomography, magnetic resonanceimaging, computed tomography angiography, digital subtractionangiography and so on. In order to explore the etiology, clinicalmanifestation, the change of the auxiliary examination, diagnosis,optimum treatment and results, enhance the understand of this disease,we carried on one year's track by calling patients regularly who havecome our hospital during the period of 2003-2004, and performedperspective analysis of original data, then we discuss the conceptionfurther more.Results: Most patients of transient ischemic attack are elderpersons, especially at the age of 50-70 years old, the proportion ofmen and women are 2.44:1. The main pathogenesis are: (1)microembolization theory: the microembolism which is made up oferythrocyte, platelet, leukocyte and cholesterol crystal follow theblood enter the encephalon engender microembolization, then thelocal symptom appears, when it break out or move to farness, thesymptom disappears, we think it maybe the main etiology which leadthe elder patients attack; (2) hemodynamics change: theatherosclerosis causes the arteries severe striatness or obturated , it issupplied with collateral circulation usually,the symptom appears whenthe blood press fall, and the symptom disappears while it rise; (3)vasospasm: the atherosclerosis lead the arteries straitness, overfall willcome into being because the hemal wall is not smooth; the symptomsappear when the overfall accelerate which induce vasospasm, thevasospasm disappear when the blood calm. We think it maybe themain etiology which lead the younger patients attack; (4) Bloodcomponent change: erythrocyte or leukocyte accumulate or bloodhypercoagulation tendency lead microvessel emphraxis, they all canlead attack. The most patients with transient ischemic attack haveblood hypercoagulation tendency; (5) others: arteritis also can leadattack. The risking factors involve hypertension, diabetes, smoking,drinking and so on. The above-mentioned pathogenesis interact, whichlead transient ischemic attack. The most patients with internal carotidarterial system TIA represent hemiplegia, unilateral sensorydysfunction, aphasia and so on. The appearances of Vertebrobasilararterial system are paroxysmal vertigo, diplopia, dysphagia. Theaverage age of the latter (65.33 years old) is elder than that of theformer (59.03 years old). The duration of most patients are within 10minutes, few exceed 2 hours. The positive ratio of TCD, cranial CT,cranial MRI, carotid artery color ultrasonography, DSA, CTA,examination was 68.37%, 63.33%, 85.71%, 83.33%, 62.5%, 66.67%respectively. The computed tomography angiography, digitalsubtraction angiography can observe the pathologica location andcomplexion. Conclusion: We can conclude following conclusion by analysisthe original data of the 148 patients. Most patients are elder peoplewho have the risking factors of the cerebrovascular diseases, most ofthem are within 50-70 years old, but the younger patients areincreasing, and the men exceed women obviously. Typical clinicalmanifestation are repeated, straitlaced hemiplegia, unilateral sensorydysfunction, aphasia, vertigo, diplopia, dysphagia and so on. Theduration is mostly within 10 minutes, few exceed 2 hours. Thepathogenesis including microembolization, vasospasm,hemodynamics change and so on. But we can not explain straitlacedattack, so we think etiology is various factors interact on the base ofatherosclerosis. We should examine patients minutely, refer variousauxiliary examinations for the sake of excluding diseases which aresimilar to TIA, in order to prevent delaying the treatment. Nowcomputed tomography angiography can substitute digital subtractionangiography, if the digital subtraction angiography only use asexamination. We should implement comprehensive therapies whichaim at all kinds of pathogenesis. We can apply intravascular...