[Transient cerebral ischemic complications. The neurologist's point of view].
Transient ischaemic attacks (TIA) are defined by the focal and sudden loss of a cerebral function or the vision of one eye, resolving without sequelae within 24 hours and related to a vascular cause, thromboembolic much more frequently than haemodynamic. TIA represent between 9% and 25% of all cerebrovascular accident (CVA) with a variable global incidence from one study to another, between 0.2 and 3.3/1,000/year. The natural history of TIA is characterized by an excess mortality and an increased risk of cerebral infarction and myocardial infarction. It is therefore essential to recognize these events in order to prescribe effective preventive treatment. The clinical picture is characterized by a usually brief focal deficit (2 to 30 min, on average) and a normal clinical examination. The diagnosis is therefore exclusively based on the clinical interview. Complementary investigations have a dual objective: 1) to eliminate other diseases likely to cause transient neurological manifestations, and 2) to detect the mechanism and cause of cerebral ischaemia; the commonest causes are atheromatous stenosis and emboligenic heart disease. In addition to the routine laboratory examinations, basic complementary investigations consist of cerebral CT scan, cervical ultrasound and echocardiography. Conventional angiography is performed less and less frequently due to the progress in ultrasound and vascular imaging (helicoidal CT scan and magnetic resonance angiography). The treatment of TIA is designed to prevent cerebral and myocardial infarction, and to decrease the cardiovascular mortality [2]. In the short-term, it is essentially based on heparin, while waiting for the results of the aetiological assessment.(ABSTRACT TRUNCATED AT 250 WORDS)
el Amrani
M
M
Service de Neurologie, Hôpital Saint-Antoine, Paris.
Bousser
M G
MG
D001161:Arteriosclerosis / Q000150:complications; D004617:Embolism / Q000150:complications; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors
Accidents ischémiques cérébraux transitoires. Le point du vue du neurologue.