Bere tiaa mu Ischemic Attack (TIA / Mini-Stroke) ne Stroke a Wosiw Ntɛmntɛm¶

Bere tiaa mu ischemic attack (TIA), a wɔtaa frɛ no mini-stroke anaa warning stroke, ba bere a mogya a ɛtɔ anaasɛ plaque asinasin siw ntini bi a ɛde amemene anaa aniwa no ma no kwan bere tiaa bi, na ɛde akisikuru ho sɛnkyerɛnne a ɛba mpofirim a ɛte sɛ nea ɛyera koraa wɔ simma kosi dɔnhwerew biako mu ba no. Esiane sɛ mogya a ɛtɔ gu nipadua no mu no mu paapae anaasɛ ɛporɔw n’ankasa ansa na ama amemene mu nkwammoaa atrɛw nti, nnipa pii di mfomso a edi awu a ɛne sɛ wɔbɛsan akɔda anaa wɔbɛtwɛn nna kakraa bi afrɛ wɔn abusua oduruyɛfo. Nokwarem no, TIA yɛ aduruyɛ mu tebea a egye ntɛmpɛ: nnipa a wɔanya TIA no mu bɛyɛ ɔha biara mu nkyem 10 kosi 15 benya akisikuru kɛse a edi dɛm anaasɛ edi awu wɔ nnafua 90 a edi hɔ no mu, na ɛkame ayɛ sɛ saa akisikuru a ɛyɛ hu no mu fã ba wɔ nnɔnhwerew 24 kosi 48 a edi kan no mu. Ayaresabea nhwehwɛmu a wɔyɛ ntɛm ara da koro no ara pɛpɛɛpɛ no ma saa asiane a ɛwɔ hɔ sɛ obi benya ɔyare a ɛma obi hwe ase ntɛm no so tew bɛyɛ ɔha biara mu nkyem 80.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara, sɛ mpo yareɛ no ho sɛnkyerɛnne biara agyae koraa a. Brɛ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom Kuo no nyinaa mu, 999 wɔ United Kingdom, anaa hwɛ ne nyinaa nɔma ahorow a egye ntɛmpɛ. Ka kyerɛ nea ɔde amena no pefee sɛ: "Ɔyarefo no nyaa akisikuru ho sɛnkyerɛnne mpofirim a ɛkɔɔ so simma [X] nkyɛe na ebia na ɔwɔ Transient Ischemic Attack anaasɛ ɔyare a ɛrekɔ so." Bisa sɛ wɔmfa no nkɔ Stroke Center a wɔagye atom.
2. Kyerɛw simma pɔtee a sɛnkyerɛnne ahorow no fii ase ("Last Known Well" bere) ne simma pɔtee a wogyaee. Ntini ho animdefo a wɔhwɛ ntɛmpɛ mu no de wɔn ho to dɔn pɔtee a efi ase ne bere tenten a wɔde bu ɔyarefo no ho akontaa ntɛm ara wɔ nnɔnhwerew 24 mu na wɔahu sɛ ɔfata sɛ wɔde aduru a ɛma mogya tu no fi ntini mu (thrombolysis) sɛ sɛnkyerɛnne no san ba mpofirim bere a ɔwɔ ambulance no mu a anaasɛ dan a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ mu.
3. MMFA aspirin, clopidogrel, ibuprofen, anaa mogya a ɛma mogya tu biara mma kosi sɛ ayaresabea CT scan bɛma amemene mu mogya atu. Bere a wofi ase yɛ aduru abien a ekum mogya nkwammoaa (aspirin ne clopidogrel anaa ticagrelor) wɔ dwumadibea a wɔhwɛ ntɛmpɛ so wɔ neuroimaging akyi pɛɛ no, aspirin a wobɛnom wɔ fie ansa na wɔayɛ wo ti CT scan no yɛ asiane efisɛ mogya a ɛtɔ kɔ nipadua mu a ɛma mogya tu betumi de ntini mu sɛnkyerɛnne ntiantiaa a ɛtra hɔ bere tiaa bi aba.
4. Ma onipa no nnyɛ hwee katee wɔ ano (NPO) na ɔntra ase anaasɛ ɔda hɔ yiye a ne ti yɛ digrii 30. Mma aduan, nsu, anaa nnuru a wɔnom, efisɛ bere tiaa mu amemene mu ntini mu ischemia taa sɛe gag ne mene reflexes a enni akyi sɛnkyerɛnne a ɛda adi pefee, na ɛde asiane kɛse ba sɛ obi bɛbɔ anaasɛ aspiration pneumonia.
5. Yɛ BE-FAST ntini mu nhwehwɛmu bio simma 5 kosi 10 biara bere a woretwɛn nnuruyɛfo a wɔboa wɔn. Hwɛ yiye wɔ crescendo TIAs (a wɔsan frɛ no capsular warning syndrome), baabi a sɛnkyerɛnne ahorow no ba na ɛkɔ mpɛn pii bɛboro dɔnhwerew biako ansa na woatoto mu wɔ obubuafo a ɛtra hɔ daa mu. Sɛ sɛnkyerɛnne ahorow no san ba a, bɔ adwumayɛfo a wɔhwɛ ntɛmpɛ so kɔkɔ sɛ TIA no adan ayɛ nea ɛyɛ adwuma ɔyare a ɛma obi hwe ase.
6. Hwɛ asikre a ɛwɔ mogya mu sɛ onipa no wɔ asikreyare a, na susuw sɛnea ne koma bɔ ne mogya mmoroso sɛ nnwinnade bɛn hɔ a. Asikre a ɛba mogya mu kɛse (asikreyare ho nsɛm a egye ntɛmpɛ a glucose nnu \(3.9\text{ mmol/L}\) anaa \(70\text{ mg/dL}\)) betumi asuasua TIA bi pɛpɛɛpɛ. Sɛ wowɔ pulse oximeter anaa blood pressure cuff a, hyɛ no nsow sɛ pulse no nyɛ pɛpɛɛpɛ (a ɛkyerɛ sɛ atrial fibrillation) na kyerɛw mogya mmoroso no to hɔ a wommɔ mmɔden sɛ wobɛtew so wɔ fie.

Ntɛmntɛm triage ne TIA nhwehwɛmu gyinaesi dua¶

Fa saa ayaresabea nhyehyɛe yi di dwuma de bua bere a obi nya ntini anaa aniwa mu sɛnkyerɛnne ahorow mpofirim, sɛ́ ebia saa sɛnkyerɛnne ahorow no da so ara wɔ hɔ anaasɛ afi hɔ koraa no.

flowchart TD
    Start["Sudden Neurological anaa Visual Episode:<br/>Balance loss, Aniwa anifurae/aniwa mmɔho abien,<br/>Anim a ɛtɔ, Abasa/nan a ɛyɛ mmerɛw anaasɛ ɛyɛ mmerɛw,<br/>Ɔkasa a ɛyɛ mmerɛw anaa nsɛmfua a ɛyɛ basaa"] --> ActiveCheck{"So sɛnkyerɛnne ahorow no bi<br/>da so ara wɔ hɔ mprempren?"}

    ActiveCheck -->|"YIW: Ɔyɛ mmerɛw anaa nsɛmfua a wɔhwehwɛ mu home mpo"| ActiveStroke["ACTIVE STROKE CODE (Hwɛ Stroke Akwankyerɛ):<br/>1. Frɛ 911 / 112 / 999 Ntɛm ara<br/>2. Kyerɛw ‘Last Known Well’ bere pɔtee<br/>3. Fa NPO sie; MFA aspirin mma ansa na wɔayɛ CT scan<br/>4. Fa ahopere kɔ Thrombectomy / Thrombolysis Center"]

    ActiveCheck -->|"DABI: Nsɛnkyerɛnne no gyaee 100% san kɔɔ mfiase"| SuspectTIA["WOSUSUW sɛ ISCHEMIC ATTACK A ƐYƐ TRANSIENT (TIA)<br/>(Nnɔnhwerew 24 kosi 48 Mfɛnsere a Ɛsen Biara a Ɛma Ɔhaw Kɛse)"]

    SuspectTIA --> CallEMS["Frɛ 911 / 112 / 999 Ntɛm ara:<br/>Ntwɛn sɛ wobɛkɔ ayaresabea ɔkyena.<br/>MMFA ɔyarefo no ankasa nka kar."]

    CallEMS --> HomeSafety["Anamɔn a Wɔde Bɔ Ahobammɔ Ansa na Wɔakɔ Ayaresabea:<br/>1. MMFA Aspirin mma kosi sɛ amemene mu CT bɛpow mogya a ɛbɛba<br/>2. Fa NPO sie (aduan, anonne, anaa nnuru a wɔnom nni hɔ)<br/>3. Kyerɛw bere pɔtee a efi ase, bere tenten, ne sintɔ pɔtee<br/>4. San hwɛ BE-FAST simma 5-10 biara sɛ ebia ɛsan ba bio anaa"]

    HomeSafety --> RiskCheck{"Hwɛ High-Risk ABCD2 & Vascular Red Flags:<br/>- Ɔkasa mu basabasayɛ anaasɛ ɔfã biako mmerɛwyɛ?<br/>- Episode dii >= simma 10?<br/>- Nsɛm pii a ɛtoatoa so ('Crescendo TIA')?<br/>- Atrial fibrillation a wonim, carotid bruit, anaa mfe a obi adi >= 60?<br/>- Ntama a ɛnyɛ yaw mpofirim wɔ aniwa biako so (Amaurosis Fugax)?"}

    RiskCheck -->|"Biribiara a Ɛwɔ Hɔ Mprempren anaa Nea Wonsi Pii"| HospitalWorkup["Ayaresabea Adwuma a Wɔyɛ no Dɔnhwerew Koro mu Ntɛm ara:<br/>1. Ti CT + CT Angiogram (Ti & Kɔn) a ɛnyɛ nsonsonoe<br/>2. Amemene MRI a Wɔde Kari Ntrɛwmu (DWI)<br/>3. 12-Kɔbere ECG & Telemetry ma Atrial Fibrillation<br/>4. Ntɛm ara Dual Antiplatelet Therapy (DAPT) bere a wɔpow mogya no"]

Nea ɛkɔ so wɔ amemene no mu bere a wɔreyɛ TIA (ne nea enti a nnɔnhwerew 24 nkyerɛase dedaw no sesae) .¶

Mfe du du pii no, aduruyɛ ho adesua nhoma ahorow de nkyerɛkyerɛmu a egyina bere so a wɔmpɛ dii dwuma maa TIA: ntini mu yare biara a ɛba mpofirim a ɛtra hɔ nnu nnɔnhwerew 24. Nnɛyi ntini mu mfoniniyɛ a wɔde Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) dii dwuma no daa no adi sɛ saa nkyerɛase dedaw yi yɛ nea ɛdaadaa nnipa wɔ ɔkwan a asiane wom so. Nhwehwɛmu ahorow a Amerika Koma Fekuw (AHA) ne Amerika Akisikuru Fekuw (ASA) yɛe no daa no adi sɛ ayarefo a wɔn akisikuru ho sɛnkyerɛnne no fi hɔ wɔ nnɔnhwerew 1 kosi 24 mu no mu ɔha biara mu 30 kosi 50 wɔ amemene mu ntini a awuwu a ɛtra hɔ daa, a ɛyɛ nketenkete ankasa wɔ MRI mfonini mu.

Ɛnnɛ, AHA/ASA, Europa Akisikuru Ahyehyɛde (ESO), ne Wiase Akwahosan Ahyehyɛde de nnɛyi nkyerɛkyerɛmu a egyina ntini so di dwuma: - Transient Ischemic Attack (TIA): Bere tiaa mu ntini mu yare a ɛnam amemene a ɛkɔ so, akyi berɛmo, anaa retinal ischemia, a enni acute infarction (ntini a ɛwuwu daa) wɔ amemene mu mfoniniyɛ so. Nokware TIA dodow no ara di simma 2 kosi 15 pɛ; sɛ sika a ɛho nhia no kyɛ boro simma 60 pɛ a, nea ennu ɔha biara mu nkyem 15 gyae wɔ nnɔnhwerew 24 mu a ennyaw akuru a ɛtra hɔ daa wɔ MRI so. - Nea enti a TIA ba: Crystal anaa cholesterol crystal pae fi kɔn mu ntini a ayɛ teateaa (internal carotid anaa vertebral artery stenosis) anaa koma (atrial fibrillation anaa koma valve), anaa ntini ketewaa bi a ɛkɔ akyiri a ɛkɔ amemene no mu a ɛyɛ mmerɛw na ɛtwetwe (lacunar ischemia). Simma kakraa bi no, ntini a ɛwɔ nsu no ase no hwere mogya a ɛkɔ fam sen anyinam ahoɔden a entumi nyɛ adwuma yiye (\(<20\text{ mL/100g/min}\)) na egyae tuo a wɔtow, na ɛma obi yɛ obubuafo, ne ho yɛ no yaw, anaasɛ n’ani afura. Ansa na ntini no betwa nkwammoaa-owu a wontumi nsakra no (\(<10\text{ mL/100g/min}\)) no, abɔde mu mogya mu enzymes tew mogya a ɛtwetwe no anaasɛ ntini a ɛka ho no bue, na ɛsan yɛ adwuma. - Nea enti a nnɔnhwerew 24 kosi 48 a edi hɔ no ho hia: Akuru a entumi nnyina wɔ kɔn mu ntini mu anaasɛ ɔdan a ɛma mogya tu wɔ koma no mu a ɛtow saa "kɔkɔbɔ tuo" a edi kan no da so ara de nsiyɛ rehwie mogya a ɛtɔ. Sɛ wɔannya aduruyɛ mu den ntɛm ara a, mogya a edi hɔ a wɔtow gu nnɔnhwerew kakraa bi akyi no taa yɛ kɛse na ɛde ɔyare a ɛtra hɔ daa a ɛyɛ hu ba.

TIA sɛnkyerɛnne ahorow a wɔtaa hu ne nea ɛnyɛ nea wɔtaa hu no a wobehu¶

Esiane sɛ amemene no di dwumadi ahorow so wɔ ntini akɛse abiɛsa mu nti, ɛnyɛ bere nyinaa na TIA te sɛ television so mfonini a wɔtaa de di dwuma a ɛkyerɛ anim a ahwe ase ne ne nsa a abubu. Fa BE-FAST nhwehwɛmu a wɔatrɛw mu no di dwuma na hu nipadua mu nhyehyɛe pɔtee abiɛsa no:

1. Anterior Circulation TIA (Carotid a Ɛwɔ Mu & Mfinimfini Amemene Ntini Asasesin) .¶

• Amaurosis Fugax ("Fleeting Blindness" in One Eye): Aniwa ntini no ne nkorabata a edi kan koraa a efi carotid ntini a ɛwɔ mu a ɛwɔ ti nhwi no mu no mu. Sɛ cholesterol crystal (Hollenhorst plaque) anaa mogya nkwammoaa a ɛtwetwe mogya fi carotid ntini a ayɛ teateaa wɔ kɔn no mu a, ɛtaa tow kɔ ani biako retina ntini no mu tẽẽ. Ayarefo ka "sunsuma tuntum, ntama a ɛyɛ fitaa, anaa Venetian anifurae a ɛtwe kɔ fam anaasɛ ɛfa aniwa biako so" a ɛtra hɔ simma 1 kosi 10 na afei ɛsan kɔ soro bio ho asɛm.
• Contralateral Weakness or Numbness: Mmerewa a ɛba mpofirim, emu yɛ duru, ɛyɛ mmerɛw, anaasɛ ɛyɛ mmerɛw a awu wɔ anim, nsa, ne/anaasɛ nan a ɛwɔ nipadua no fã a ɛne no bɔ abira (sɛ nhwɛso no, benkum carotid artery TIA ma anim nifa so hwe ase na nsa nifa yɛ mmerɛw).
• Aphasia anaa Dysarthria (Language & Speech Loss): Sɛ ɛkamene no fã a ɛwɔ tumi kɛse (ɛkame ayɛ sɛ bere nyinaa amemene no benkum so) a, ebia mpofirim ara onipa no rentumi nkasa, ɔde nsɛmfua a ɛnteɛ besi ananmu (asɛmfua salad), anaasɛ ɔrentumi nte nsɛmfua a wɔaka anaa wɔakyerɛw ase (receptive aphasia), simma 3 pɛ mpo.

2. Akyi Nkyinhyia TIA (Vertebrobasilar Asasesin, Ɛtaa Pam wɔ Triage mu) .¶

Akyi berɛmo mu ntini abien ne basilar ntini no ma amemene no dua, amemene no mu ntini, ne occipital visual lobes no ma. Wɔtaa hu akyi TIA ahorow no wɔ ɔkwan a ɛnteɛ so sɛ aso mu a ɛyɛ mmerɛw anaasɛ ɔbrɛ: - Homonymous Hemianopia: Aniwa no fã benkum anaa nifa fã a ɛyera mpofirim wɔ ani abien no nyinaa mu bere koro mu. - The "5 Ds" of Brainstem Ischemia: Mpofirim Dizziness/Vertigo (a ɛyɛ twitwiw a ɛne ntini mu sɛnkyerɛnne afoforo bom), Diplopia (anisoadehu mmɔho abien mpofirim bere a aniwa abien no nyinaa abue), Dysarthria (ɔkasa a ɛyɛ mmerɛw), Dysphagia (ɛyɛ den mpofirim sɛ ɔbɛmene), ne Dystaxia/Ataxia (mpofirim a wontumi nnantew tẽẽ anaasɛ wɔmfa nsateaa bi nkɔ hwene no mu pɛpɛɛpɛ). - Crossed Neurological Deficits: Anim no fã biako a ɛyɛ mmerɛw a ɛne nipadua no fã a ɛne no bɔ abira a ɛyɛ mmerɛw anaasɛ ɛyɛ mmerɛw.

3. Capsular Kɔkɔbɔ Yare ("Crescendo TIAs") .¶

Wɔ capsular warning syndrome mu no, bere tiaa mu a esiw ntini ketewaa biako a ɛhyɛn mu (mpɛn pii no lenticulostriate nkorabata a ɛma capsule no mu aduan, baabi a motor nerve fibers nyinaa bom denneennen) no ma 3 kosi 10+ akyi-akyi nsɛm a ɛma anim, nsa, ne nan no yɛ obubuafo koraa wɔ ɔfã biako wɔ nnɔnhwerew 12 kosi 24 mu. Wɔ nsɛm a ɛkɔ so no ntam no, onipa no te sɛ nea ɔte ase koraa simma 20, afei mpofirim ara ɔhwere ne ho nyinaa bio wɔ ɔfã biako. Ayarefo a wɔwɔ capsular warning syndrome no mu bɛyɛ ɔha biara mu nkyem 40 nya nkɔso kɔ akisikuru a ɛtra hɔ daa, a ɛma obi di dɛm wɔ nna kakraa bi mu, na ɛma ɛyɛ ahyɛde sɛ wɔde wɔn kɔ ICU/Stroke Unit ntɛm ara.

Ntotoe a ɛkɔ akyiri: TIA vs. Completed Stroke vs. Common TIA Mimics¶

Nnuruyɛfo a wɔhwɛ ntɛmpɛ so hwehwɛ tebea horow pii a ɛnyɛ hu na ɛyɛ hu ("TIA mimics") a ebetumi asuasua mini-stroke bere tiaa bi. Fa nneɛma a ɛwɔ ase ha no toto ho:

Asiane a ɛwɔ hɔ sɛ obi benya ɔyare a ɛma obi hwe ase ntɛm ara ho akontaabu: ABCD2 Ayaresabea Nkonimdi¶

Dwumadibea ahorow a wɔhwɛ ntɛmpɛ so wɔ wiase nyinaa de ABCD2 Nkonimdi a wɔagye atom no di dwuma ka ntini mu mfoniniyɛ ho de kyerɛ sɛnea ɛbɛyɛ yiye sɛ TIA ɔyarefo bi benya akisikuru a edi mũ wɔ ** nnɔnhwerew 48** a edi hɔ no mu. Sɛ yɛte nneɛma anum yi ase a, ɛkyerɛ nea enti a nnuruyɛfo a wɔboa nkurɔfo ne ayaresabea ahorow di TIA ahorow bi ho dwuma sɛ tebea horow a egye ntɛmpɛ a wɔde kɔkɔbɔ anum di dwuma:

Nea ABCD2 Nkonimdie Nyinaa (0 kɔsi 7 Nkonimdie) kyerɛ:¶

• Score 0 to 3 (Low Score, nanso NEVER Zero Risk): bɛyɛ \(1.0\text{ ɔha biara mu}\) asiane a ɛwɔ hɔ sɛ obi benya akisikuru kɛse wɔ nnɔnhwerew 48 mu. Kɔkɔbɔ a ɛho hia a efi NICE (UK) ne AHA/ASA: Ɔyarefo a ɔwɔ ABCD2 nkyerɛwde a ɛyɛ \(0\text{ anaa }1\) mpo betumi anya carotid ntini a asiw ɔha biara mu nkyem 90** (sɛ nhwɛso no, obi a wadi mfe 55 a onni asikreyare a n’ani biako ani afura simma 3 fi amaurosis fugax mu no nya \(0\text{ points}\) wɔ so ABCD2 da so ara hia carotid oprehyɛn a egye ntɛmpɛ). Enti, nnɛyi akwankyerɛ ahorow kamfo kyerɛ sɛ da koro neuroimaging ne vascular imaging a egye ntɛmpɛ ma TIA ahorow a wosusuw sɛ ɛyɛ NYINAA, a ABCD2 nkontaahyɛde mfa ho.
• Score 4 to 5 (Moderate-High Risk): \(4.1\text{ ɔha biara mu}\) asiane a ɛwɔ hɔ sɛ obi benya ɔyare a ɛma obi hwe ase wɔ nnɔnhwerew 48 mu; botae a wɔde asi wɔn ani so sɛ wɔde wɔn bɛkɔ ayaresabea ntɛm ara ne aduru abien a wɔde ko tia mogya nkwammoaa (DAPT).
• Nkonimdi 6 kosi 7 (Asiane a Ɛyɛ Den): \(8.1+\text{ ɔha biara mu}\) asiane a ɛwɔ hɔ sɛ ɛbɛma ɔyare a ɛma obi hwe ase no ayɛ adwuma wɔ nnɔnhwerew 48 mu (na ɛboro saa mpo sɛ carotid stenosis anaa atrial fibrillation wɔ hɔ a).

Nea enti a ƐNSƐ sɛ woma aspirin wɔ fie ansa na wɔayɛ amemene CT scan: "Amyloid Spell" Afiri no¶

Asɛmmisa a wɔtaa fi mmusua hɔ ne sɛ: "Sɛ TIA fi mogya a ɛtɔ ketewaa bi mu a, so ɛnsɛ sɛ yɛma aspirin aduru a emu duru yɛ 300 mg ntɛm ara wɔ fie?" Nnɛyi ntini ho akwankyerɛ (a UK National Institute for Health and Care Excellence [NICE NG128] ka ho ne AHA/ASA Acute Stroke Guidelines) de afotu ma twɛn kosi sɛ wɔbɛyɛ amemene ho mfonini ntɛm (CT anaa MRI) yɛ wɔ dwumadibea a wɔhwɛ ntɛmpɛ so ansa na wɔde aspirin ama bere biara a wobetumi de kar akɔ ntɛm ara, esiane nneɛma abien a egye nkwa nti:

1. Transient Focal Neurological Episodes ("Amyloid Spells"): Wɔ mpanyimfo a wɔadi boro mfe 60 mu no, tebea bi a wɔfrɛ no Cerebral Amyloid Angiopathy (CAA) ma mogya ntini nketenkete a ɛwɔ amemene no akyi no yɛ mmerɛw. Sɛ saa ntini a ɛwɔ soro yi mu biako ma mogya ketewaa bi kɔ amemene no mu ntini mu (convexity subarachnoid hemorrhage anaa cortical superficial siderosis) a, ɛhyɛ nkate anaa ntini a ɛma nipadua no yɛ adwuma no abufuw, na ɛde simma 5 kosi 15 a ɛtrɛw a ɛyɛ mmerɛw, ɛyɛ yaw, anaa mmerɛwyɛ wɔ nsa biako ne anim a ɛte sɛ nea ɛte sɛ a TIA**. Sɛ wɔde aspirin anaa clopidogrel ma ɔyarefo a ɔwɔ "amyloid spell" a, ebetumi ama mogya a ɛtɔ kɛse a edi awu wɔ lobar amemene mu wɔ nnɔnhwerew kakraa bi mu.
2. Evolving Hemorrhagic Stroke: Mogya nketenkete a emu dɔ a ɛba amemene mu no betumi afi ase bere ne bere mu denam akasakasa anaasɛ sɛnkyerɛnne a emu nyɛ den so ansa na atrɛw. Ti CT scan a ɛnyɛ nea ɛne ne ho nhyia wɔ dan a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ mu no gye nea ennu simma 5 na ɛkyerɛ ntɛm ara sɛ ebia mogya retu anaa.

Nea ɛkɔ so wɔ Dwumadibea a Ɛho Hia Ntɛmntɛm: Sɛnea ayaresabea a wɔhwɛ no da koro no siw akisikuru 80% ano¶

Ayaresabea a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ TIA adwumayɛ mu adum anan a wɔbɛte ase no kyerɛkyerɛ nea enti a nna abien a wɔbɛtwɛn ma wɔakɔ ayaresabea a wɔhwɛ ayarefo a wɔda abɔnten no yɛ asiane kɛse no mu:

1. Amemene ne Kɔn Ntini Ho Mfonini a Wɔyɛ Ntɛm ara (CT, CTA, ne DWI-MRI) .¶

• Non-Contrast Head CT: Ɛpow amemene mu mogya a ɛtɔ ntɛmntɛm anaasɛ amemene mu akisikuru wɔ simma kakraa bi mu.
• CT Angiography (CTA) a ɛfa Ti ne Kɔn ho (anaasɛ Carotid Duplex Ultrasound): Ɛkyerɛ ntini a efi aortic arch no kɔ soro fa kɔn no mu (carotid ne vertebral ntini) na ɛkɔ amemene no mu (Circle of Willis).
• Nea enti a eyi ntumi ntwɛn: Sɛ CTA anaa ultrasound da symptomatic severe internal carotid artery stenosis (\(70\text{ to }99\text{ percent}\) narrowing, anaa \(50\text{ to }69\text{ percent}\) wɔ ayarefo a wɔapaw wɔn mu) adi wɔ ɔfã a ɛde TIA bae no so a, ntini mu oprehyɛn ho animdefo yɛ Carotid Endarterectomy (CEA) (oprehyɛn a wɔde tew plaque no ho) anaasɛ carotid stenting wɔ nnɔnhwerew 48 kosi nnafua 14 mu. Sɛ wɔyɛ carotid oprehyɛn wɔ nna a edi kan wɔ TIA akyi a, esiw akisikuru a edi awu ano; sɛ wɔtwɛn bɛboro adapɛn kakraa bi a, ɛhwere mfaso a ɛwɔ ahobammɔ no mu dodow no ara efisɛ ɔyare kɛse no asi dedaw.

2. Ntɛm ara Dual Antiplatelet Therapy (DAPT): CHANCE ne POINT Sɔhwɛ Nhyehyɛe no¶

Sɛ dwumadibea a wɔhwɛ ntɛmpɛ so panyin no CT pow amemene mu mogya a ɛretu na adwuma no yi koma no mu ntini a ɛtwetwe a ɛhwehwɛ sɛ wɔde nnuru a ekum mogya a ɛtɔ kɔ nipadua no mu koraa no fi mu pɛ a: - Wɔ ayarefo a wɔwɔ Asiane kɛse TIA (ABCD2 nkontabuo \(\ge 4\)) anaasɛ ischemic stroke ketewaa bi a wɔduru hɔ wɔ nnɔnhwereɛ 24 kɔsi 72 mu no, nnuruyɛfoɔ a wɔhwɛ ntɛmpɛ mu no de nnuru mmienu a ɛko tia mogya mu nkwammoaa kɔkɔɔ bom loading dose ma ntɛm ara (Dual Antiplatelet Therapy, anaa DAPT): mpɛn pii no aspirin ne clopidogrel (anaasɛ aspirin a wɔde ka ho ticagrelor, a egyina CHANCE, POINT, THALES, ne INSPIRES ayaresabea sɔhwɛ ahorow a ɛyɛ nwonwa so) ma mfɛnsere tiawa a ɛyɛ nnafua 21, na ɛno akyi no, wɔde aduru biako a wɔde sa yare bere tenten. - Sɛ wofi DAPT ase wɔ nnɔnhwerew 24 a edi kan no mu a, ɛtew asiane a ɛwɔ hɔ sɛ obi benya ɔyare kɛse wɔ adapɛn a edi kan no mu so kɛse bere a wɔde toto aspirin nkutoo ho no, na mfaso kɛse no ba wɔ ** nnɔnhwerew 24 kosi 72 a edi kan** no mu.

3. Koma mu Nneyɛe a Wɔhwɛ So Hwɛ Atiridiinini a Ahintaw¶

Bɛyɛ 1 wɔ 5 biara mu ischemic strokes ne TIAs fi mogya a ɛtɔ fi koma no benkum atrial appendage mu esiane Atrial Fibrillation (AFib), koma a ɛnyɛ pɛpɛɛpɛ a ɛtaa ba na ɛkɔ komm (paroxysmal atrial fibrillation) nti. - Sɛ TIA fi atrial fibrillation a, sɛ wɔde toto ho a, aspirin a wɔtaa de di dwuma no ntumi nyɛ adwuma yiye; mmom no, ɔyarefo no hia anom aduru a ekum mogya a ɛtwetwe mogya (te sɛ apixaban, rivaroxaban, dabigatran, edoxaban, anaa warfarin), a ɛtew asiane a ɛwɔ hɔ sɛ obenya ɔyare a ɛma obi hwe ase no so bɛyɛ ɔha biara mu 65 kosi 70. - Kuw a wɔhwɛ ntɛmpɛ so no yɛ ECG a ɛwɔ kɔbere 12, koma ho telemetry a ɛkɔ so wɔ mpa ho, echocardiogram, na wɔtaa de ɔyarefo no kɔ fie de cardiac patch monitor a wɔhyɛ anaasɛ loop recorder a wɔde hyɛ nipadua mu.

4. Statin Plaque a Ɛyɛ Den a Ɛma Ɛyɛ Den ne Mogya Nhyɛso a Wɔhwɛ So¶

Nnuruyɛfo a wɔhwɛ ntɛmpɛ so nso fi ase statin ayaresa a ano yɛ den kɛse (te sɛ atorvastatin anaa rosuvastatin) ntɛm ara de ma ntini mu ntini a ɛho ayɛ hyew no gyina na ɛma ntini no mu ntini no dwo, ka mogya mmoroso a wɔde bere tenten siw ano a wɔde ahwɛyiye yɛ ho.

Ɔhwɛ a wɔyɛ no anammɔn anammɔn ansa na wɔakɔ ayaresabea bere a wɔretwɛn ambulance no¶

1. Fa onipa no si baabi a dwoodwoo na bara karka:
2. Ma onipa no ntena nkongua a ɛboa no so anaasɛ ɔntra mpa anaa mpa so a wɔde ne ti ne ne mmati gyina 30-degree angle.
3. Mma obi a ɔwɔ TIA nkyɛe no kwan da sɛ ɔmfa kar nkɔ ayaresabea anaasɛ ɔhwɛ a egye ntɛmpɛ. TIA a ɛto so abien anaasɛ akisikuru a edi kan taa ba simma 15 wɔ nea edi kan no akyi bere a onipa no di kar no akyi wɔ ɔkwan kɛse no so.
4. Yɛ na kyerɛw mfitiaseɛ 6-point BE-FAST nhwehwɛmu:
5. B (Balance): So wobetumi agyina anaa anantew pintinn wɔ episode no mu, na wɔn balance te dɛn mprempren?
6. E (Aniwa): So wɔhweree anisoadehu wɔ aniwa biako mu ("curtain coming down") anaasɛ wohuu mmɔho abien? Hwɛ aniwa abien no nyinaa mprempren.
7. F (Face): Bisa wɔn sɛ wɔnserew kɛse na wɔnkyerɛ wɔn sẽ. So ano no ntwea biako hwee ase ntɛm? So ɛyɛ symmetric mprempren?
8. A (Arms & Legs): Bisa wɔn sɛ wɔnto wɔn ani na wɔnkura wɔn nsa mmienu no nyinaa mu tẽẽ wɔ anim a wɔn nsateaa hwɛ soro simma 10. Hwɛ sɛ ebia basa biako kɔ fam anaasɛ ɛdannan kɔ mu (pronator drift).
9. S (Ɔkasa): Bisa wɔn sɛ wɔnsan nka bio: "Worentumi nkyerɛkyerɛ ɔkraman dedaw bi nnɛɛdɛe foforo" anaa "Wim yɛ bruu wɔ London." Hyɛ nnyigyei nkyerɛwde a ɛyɛ mmerɛw anaa nsɛmfua a wɔtwentwɛn ne nan ase biara nsow.
10. T (Time Log): Kyerɛw dɔn bere pɔtee a episode no fii ase ne dɔn bere pɔtee a esiesiee.
11. Kye video a ɛyɛ sikɔne 30 sɛ sɛnkyerɛnne bi san hwirew bere tiaa bi a:
12. Sɛ onipa no anim a ɛtɔ, ne nsa a ɛyɛ mmerɛw, anaa ne kasa a ɛyɛ mmerɛw no san ba bere tiaa bi mu simma 60 bere a ɔretwɛn nnuruyɛfo a wɔboa no a, sɛ wɔma obi a ɔhwɛ no twa smartphone video a egye sikɔne 15 (a ɔmfa ɔhwɛ no nkyɛ) a, ɛma ayaresabea ntini ho ɔyaresafo no nya adanse a wontumi nnye ho kyim a ɛkyerɛ ntini mu asasesin pɔtee a ɛka ho no.
13. Hwɛ mogya mu glucose a ɛwɔ mogya mu ntini mu (sɛ glucometer wɔ hɔ a):
14. Sɛ onipa no nom insulin anaa sulfonylurea asikreyare nnuru a, bɔ nsateaa bi mu hwɛ sɛnea asikre wɔ mogya mu. Hypoglycemia (\(<3.9\text{ mmol/L}\) anaa \(<70\text{ mg/dL}\)) betumi de mmerɛwyɛ ne adwene a ɛyɛ basaa wɔ ɔfã biako mpofirim (hypoglycemic hemiparesis) a ɛyera bere a asikre a ɛwɔ mogya mu no san ba no aba. Sɛ mpo wohu asikre a ɛba mogya mu na wɔsa (hwɛ asikreyare ho nsɛm a egye ntɛmpɛ), wɔda so ara ma nnuruyɛfo a wɔboa ɔyarefo no hwehwɛ ɔyarefo no mu.

Nkitahodi nkyerɛwee pɔtee ma 911 / 112 / 999 ne Emergency Triage¶

Esiane sɛ TIA ɔyarefo taa yɛ sɛ nea ɔwɔ apɔwmuden koraa bere a nnuruyɛfo a wɔboa nkurɔfo fa anim pon no mu anaasɛ wɔforo kɔ dan a wɔhwɛ ntɛmpɛ mu mfɛnsere mu nti, sɛnea wokyerɛkyerɛ asɛm no mu no na ɛkyerɛ sɛ wobehu wɔn ntɛm ara anaasɛ wɔbɛtwɛn nnɔnhwerew pii wɔ dan a wɔtwɛn mu. Fa ayaresabea nkyerɛwee yi pɛpɛɛpɛ di dwuma:

• Sɛ worefrɛ 911 / 112 / 999:

  *"Mehia ambulance wɔ [Exact Address] ma obi a wosusuw sɛ Transient Ischemic Attack anaasɛ evolving stroke. Wɔ [Exact Start Time] mu no, saa [Age]-fe [ɔbarima/ɔbea] yi nyaa mpofirim [nifa/benkum anim droop / nifa/benkum basa mmerɛw / a ontumi nkasa / tuntum ntama a ɛwɔ nifa/benkum aniwa so]. Nsɛnkyerɛnne no dii akyiri simma [X] na wɔasiesie no wɔ [End Time].

• Sɛ wo ne Emergency Department Triage Nurse (sɛ wowɔ ayaresabea dedaw a):

  "Yɛhia TIA / Acute Stroke Triage nhwehwɛmu ntɛm ara. Simma aduasa a atwam ni wɔ [Bere] mu no, [ɔno] nyaa mmerɛwyɛ a efi ase mpofirim [kyerɛkyerɛ ɔfã biako mu mmerɛwyɛ, kasa a ɛyera, anaa aniwa biako anifurae pɛpɛɛpɛ mu] a ɛkyɛ [X] simma. Sɛ wogyina mfe a wadi, mogya mmoroso, ne motor/ɔkasa ho sɛnkyerɛnne so a, [ne] ABCD2 nkontaahyɛde no wɔ anyɛ yiye koraa no [⅘/6], na yɛwɔ nnɔnhwerew 24 stroke mfɛnsere a ɛho hia no mu."

Ayaresabea ahosiesie ho nhwehwɛmu kratasin ansa na ambulance no afi hɔ¶

• Bere pɔtee a wɔde fi ase ne bere a wɔde siesie nsɛm a wɔakyerɛw wɔ krataa so.
• Nnuru a wɔde di dwuma mprempren no din a edi mũ (titiriw nnuru a ɛma mogya yɛ mmerɛw te sɛ warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, anaa aspirin, a bere pɔtee a wɔmenee dodow a etwa to no ka ho).
• Ɔdansefo a ɔde n’ani huu yare no ho sɛnkyerɛnne no telefon nɔma (sɛ ɔdansefo no nte ambulance no mu a, ntini ho ɔyaresafo no bɛfrɛ wɔn ntɛm ara de akyerɛ sɛnea na adeyɛ no te).
• Medical implant cards (pacemaker, defibrillator, heart valve, anaa coronary stents, enti ayaresabea no nim sɛ ɔyarefo no betumi akɔ MRI scanner mu tẽẽ anaa).

Nsɛm a wɔtaa bisa¶

Sɛ me stroke ho sɛnkyerɛnne no yerae koraa wɔ simma 10 mu a, dɛn nti na mintumi nyɛ nhyehyɛe nkɔ m’abusua oduruyɛfo nkyɛn dapɛn a edi hɔ no ara kwa?¶

Bere tiaa mu ischemic attack (TIA) yɛ kɔkɔbɔ sɛnkyerɛnne a ɛkyerɛ sɛ ntini a entumi nnyina wɔ wo kɔn mu anaasɛ ntini bi a ɛwɔ wo koma mu no de nsiyɛ rehwie mogya a ɛtɔ kɔ w’amemene mu. Ɛkame ayɛ sɛ akisikuru akɛse a ɛma obi di dɛm daa a ɛba wɔ TIA akyi no nyinaa mu fã ba wɔ nnɔnhwerew 24 kosi 48 a edi kan no mu; sɛ wokɔ dwumadibea a wɔhwɛ ntɛmpɛ so ntɛm ara a, ɛma nnuruyɛfo tumi hwehwɛ w’amemene ne wo kɔn mu ntini ahorow mu, hu sɛ atiridiinini no ayɛ wo hyew, na wofi ase de nnuru abien a ekum mogya nkwammoaa anaa mogya a ɛtwetwe mogya di dwuma da koro no ara, na ɛtew asiane a ɛwɔ hɔ sɛ wobɛbɔ wo yare no so ɔha biara mu nkyem 80.

Dɛn ne "amaurosis fugax," na dɛn nti na wɔsa bere tiaa mu aniwa biako a ɛyera no sɛ mini-stroke?¶

Amaurosis fugax (Hela kasa mu asɛmfua a ɛkyerɛ "esum a ɛtra hɔ bere tiaa bi") yɛ aniwa biako a ɛyera a ɛnyɛ yaw, na wɔtaa ka ho asɛm sɛ ntama anaa sunsuma a ɛyɛ tumm a ɛtwe kɔ fam wɔ aniwa no so simma kakraa bi ansa na wɔama so. Esiane sɛ aniwa mu ntini a ɛma retina no aduan no ne nkorabata a edi kan a efi carotid ntini a ɛwɔ kɔn no mu no mu nti, bere tiaa bi a ɛyɛ tuntum wɔ aniwa biako mu no yɛ kɔkɔbɔ sɛnkyerɛnne a wɔtaa de kyerɛ sɛ carotid ntini a ɛyɛ teateaa kɛse a ebetumi ama obi anya ɔyare kɛse wɔ hemisphere no mu wɔ nnɔnhwerew anaa nna pii mu.

Dɛn nti na akwankyerɛ ahorow a ɛfa ntɛmpɛ ho ka sɛ ɛsɛ sɛ wɔtwɛn ayaresabea CT scan ansa na wɔanom aspirin bere a wosusuw sɛ woanya TIA akyi?¶

Bere a wofi ase fi aspirin ne clopidogrel ase ntɛm ara wɔ ayaresabea bere a CT scan akyerɛ sɛ mogya biara ntu no, mogya nketenkete a ɛba amemene no ani (te sɛ amemene mu amyloid angiopathy spells wɔ mpanyimfo a wɔn mfe akɔ anim mu) betumi ama simma 5 kosi 15 ayɛ mmerɛw anaa mmerɛwyɛ a ɛtrɛw a ɛte sɛ TIA. Aspirin a wɔnom wɔ fie ansa na wɔayɛ simma 5 ayaresabea ti CT scan ntɛmntɛm akyerɛ sɛ mogya ntu no betumi adan amemene mu mogya ketewaa bi a ɛtwetwe no ayɛ amemene mu mogya a edi awu.

So TIA betumi agyaw ɔsɛe a ɛtra hɔ daa wɔ amemene mu nhwehwɛmu so bere mpo a onipa no te nka sɛ ɔha biara mu nkyem 100 asan ayɛ ne kan tebea no?¶

Yiw, ayaresabea nhwehwɛmu ahorow a wɔde Diffusion-Weighted MRI (DWI) a ɛyɛ nwonwa di dwuma no kyerɛ sɛ ayarefo a wɔn akisikuru ho sɛnkyerɛnne no sa koraa wɔ simma kakraa bi kosi dɔnhwerew biako mu no mu bɛyɛ nkyem abiɛsa mu biako wɔ amemene mu ntini a ɛyɛ mmerɛw daa wɔ wɔn MRI mfonini no mu ankasa, na ɛno si sɛnea amemene no bɛn akisikuru a ɛyɛ hu no so dua na esi ntɛmpɛ sɛ wɔhwɛ ayaresabea ntɛm ara no so dua.

Sources a wɔhwɛɛ mu¶

• Amerika Koma Fekuw (AHA) ne Amerika Akisikuru Fekuw (ASA, United States): Akwankyerɛ a ɛfa Ayarefo a Wɔyare Akisikuru ne Bere tiaa mu Ischemic Attack a Wosiw Akisikuru Ho (Stroke, Kleindorfer ne afoforo) ne Nkyerɛase ne Nhwehwɛmu a Wɔde Ma Bere Tiaa mu Ischemic Attack: Nyansahu mu Asɛm a Wɔka ma Akwahosan Ho Adwumayɛfo (Easton ne afoforo).
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Akisikuru ne Bere tiaa mu Ischemic Ntuo a ɛba wɔ wɔn a wɔadi boro mfe 16 mu: Nhwehwɛmu ne nea edi kan a wɔde di dwuma (NICE Akwankyerɛ NG128, ntɛmpɛ nhwehwɛmu ne mfoninitwa ho nhyehyɛe).
• European Stroke Organization (ESO): Akwankyerɛ a ɛfa Transient Ischemic Attack Ho Dwumadie ho (European Stroke Journal, Fonseca ne afoforo, a aduruyɛ a ɛko tia mogya mu nkwammoaa kɔkɔɔ abien [DAPT] nyansahyɛ ahorow a efi CHANCE, POINT, ne THALES sɔhwɛ ahorow no mu ka ho).
• Canada Stroke Best Practice Recommendations (Heart and Stroke Foundation of Canada): Akisikuru a Ɛto so Abien a Wɔsiw Akisikuru ne Bere Tiaa mu Ischemic Ntua Triage ne Ntɛmntɛm Ho Akwankyerɛ.
• Wiase Akwahosan Ahyehyɛde (WHO) & Wiase Nyinaa Akisikuru Ahyehyɛde (WSO): Wiase Nyinaa Akisikuru Akwankyerɛ ne Adeyɛ Nhyehyɛe a ɛfa Acute Cerebrovascular Triage ho.

Akwankyerɛ ahorow a ɛfa ho¶

• Stroke recognition (FAST) ne ntɛmpɛ ho mmuae
• Anim a ɛyɛ mmerɛw: nsonsonoe a ɛda Bell mmubuafo ne amemene mu ntini a ɛyɛ mmerɛw ntam
• Mogya a ɛtɔ wɔ subarachnoid, aprannaa tiyɛ, ne amemene mu ntini a ɛpaapae
• Hypertensive emergency vs. ntɛmpɛ: bere a mogya mmoroso boro 180/120
• Asikreyare ho nsɛm a egye ntɛmpɛ: asikreyare a ɛba fam ne asikreyare a ɛkɔ soro mmoa a edi kan