ʻO Transient Ischemic Attack (TIA / Mini-Stroke) a me ka pale koke ʻana¶

ʻO ka transient ischemic attack (TIA), i kapa mau ʻia he mini-stroke a i ʻole warning stroke, ke hana ʻia ke hoʻopaʻa ʻia kahi ʻāpana koko a i ʻole ʻāpana plaque i kahi aʻa e hāʻawi ana i ka lolo a i ʻole ka maka, e hōʻike ana i nā hōʻailona o ka hahau koke ʻana me he mea lā e nalowale loa i loko o nā minuke a i hoʻokahi hola. Ma muli o ka haki ʻana a hoʻoheheʻe ʻia paha ka clot ma mua o ka make ʻana o ka lolo lolo, nui ka poʻe e hana hewa hewa o ka hoʻi ʻana i kahi moe a i ʻole ke kali ʻana i kekahi mau lā e kāhea i kā lākou kauka ʻohana. ʻO ka ʻoiaʻiʻo, he pilikia olakino ka TIA: ** a hiki i ka 10 a hiki i ka 15 pakeneka o ka poʻe i loaʻa i kahi TIA e loaʻa i kahi hōʻeha nui a i ʻole ka make i loko o nā lā 90 e hiki mai ana, a kokoke i ka hapalua o kēlā mau hahau pōʻino e paʻi i loko o nā hola 24 a hiki i 48 **. ʻO ka loiloi o ka haukapila ma ka lā hoʻokahi e hōʻemi i ka hopena o ka hahau mua ʻana a hiki i ka 80 pakeneka.

E hana i kēia i kēia manawa¶

1. E kelepona koke i kāu helu ulia pōpilikia, ʻoiai inā ua hoʻopau loa ʻia kēlā me kēia hōʻailona. Kāhea iā 911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ʻEulopa, 999 ma United Kingdom, a i ʻole e nānā i nā mea āpau helu pilikia. E haʻi aʻe i ka mea hoʻouna: *"Ua loaʻa i ka mea maʻi nā hōʻailona hōʻeha hikiwawe i lōʻihi [X] mau minuke a loaʻa paha i kahi Transient Ischemic Attack a i ʻole evolving stroke." * Noi i ka lawe ʻana i kahi Stroke Center i hōʻoia ʻia.
2. E kākau i lalo i ka minuke pololei i hoʻomaka ai nā hōʻailona (manawa "Last Known Well") a me ka minuke pololei a lākou i kū ai. Ke hilinaʻi nei nā neurologist pilikia i ka uaki hoʻomaka pololei a me ka lōʻihi no ka helu ʻana i ka pilikia o ka maʻi maʻi 24-hola koke a no ka hoʻoholo ʻana i ke kūpono no ka intravenous clot-busting therapy (thrombolysis) inā hoʻi koke mai nā hōʻailona i loko o ka hale kaʻa a i ʻole ke keʻena pilikia.
3. Mai hāʻawi i ka aspirin, clopidogrel, ibuprofen, a i ʻole kekahi mea hoʻokahe koko a hiki i ka hōʻike ʻana o ka haukapila CT e hoʻokuʻu i ke koko o ka lolo. ʻOiai ua hoʻomaka ʻia ka lāʻau antiplatelet ʻelua (aspirin me clopidogrel a i ʻole ticagrelor) i loko o ke keʻena pilikia koke * ma hope o * neuroimaging, lawe i ka aspirin ma ka home ma mua o ke poʻo CT scan he mea pōʻino no ka mea hiki ke hōʻike ʻia nā hōʻailona hemorrhagic stroke me nā hōʻailona pōkole, transient neurological.
4. E mālama pono i ke kanaka ma ka waha (NPO) a noho a moe ʻoluʻolu paha me ko lākou poʻo ma ke 30 degere. Mai hāʻawi i ka meaʻai, ka wai, a i ʻole nā ​​​​palapala waha, no ka mea, hoʻopilikia pinepine ʻia ka ʻōpū o ka lolo a me ka ʻai ʻana me ka ʻike ʻole ʻia o nā hōʻailona o waho, e hana ana i kahi pilikia nui o ke koko a i ʻole aspiration pneumonia.
5. E hana hou i ka BE-FAST neurological check i kēlā me kēia 5 a 10 mau minuke oiai e kali ana i ka poʻe lapaʻau. E nānā pono iā crescendo TIAs (i kapa ʻia ʻo capsular warning syndrome), kahi e hele pinepine ai nā hōʻailona ma mua o hoʻokahi hola ma mua o ka laka ʻana i ka lolo mau loa. Inā hoʻi mai nā hōʻailona, ​​e makaʻala i nā lawelawe pilikia i hoʻololi ʻia e ka TIA i mea hana hahau.
6. E nānā i ke kō koko inā loaʻa i ke kanaka ka maʻi maʻi maʻi, a e ana i ka puʻupuʻu puʻupuʻu a me ke kahe koko inā kokoke nā mea hana. He haʻahaʻa koʻikoʻi ke koko (ulia pōpilikia me ka glucose ma lalo o \(3.9\text{ mmol/L}\) a i ʻole \(70\text{ mg/dL}\)) hiki ke hoʻohālike like i ka TIA. Inā loaʻa iā ʻoe ka pulse oximeter a i ʻole ke kaomi ʻana i ke koko, e ʻike inā ʻaʻole maʻamau ka puʻuwai (he hōʻailona no atrial fibrillation) a kākau i lalo i ke kahe koko me ka ʻole o ka hoʻāʻo ʻana e hoʻohaʻahaʻa i ka hale.

ʻO ka hoʻāʻo pilikia a me ka lāʻau hoʻoholo loiloi TIA¶

E hoʻohana i kēia palapala holo kiʻi no ka pane ʻana i ka wā e ʻike ai kekahi i nā hōʻailona neurological a i ʻole nā ​​hōʻailona ʻike, inā e mau ana kēlā mau hōʻailona a i ʻole ua hemo loa.

flowchart TD
    Start["ʻĀpana Neurological Hiki ʻole:<br/>Nalo ke kaulike, makapō/ʻike pālua,<br/>Haʻule ka maka, nāwaliwali o ka lima/wāwae a i ʻole ka helu ʻana,<br/>Ka ʻōlelo a i ʻole ka huikau ʻōlelo."] --> ActiveCheck{"Aia kekahi o nā hōʻailona<br/>i kēia manawa?"}

    ActiveCheck -->|"ʻAe: ʻO ka haʻahaʻa haʻahaʻa a i ʻole ka hoʻomaha ʻana i ka ʻōlelo"| ActiveStroke["KĀWAI KĀNĀ HANA (E ʻike i ke alakaʻi no ka Stroke):<br/>1. E kelepona iā 911 / 112 / 999 koke<br/>2. E hoʻopaʻa pololei i ka manawa 'ʻike hope loa'<br/>3. E mālama iā NPO; Mai hāʻawi i ka aspirin ma mua o ka CT scan<br/>4. Holo i ka Thrombectomy / Thrombolysis Center"]

    ActiveCheck -->|"ʻAʻole: Ua hoʻoholo ʻia nā hōʻailona 100% hoʻi i ka papa kuhikuhi"| SuspectTIA["HOʻOPIʻI ʻia ʻo TRANSIENT ISCHEMIC ATTACK (TIA)<br/>(Peak 24-a-48-Hour High Stroke Window)"]

    SuspectTIA --> CallEMS["E kelepona iā 911 / 112 / 999 koke:<br/>Mai kali i ka manawa o ka lā ʻapōpō.<br/>Mai ʻae i ka mea maʻi e hoʻokele iā lākou iho."]

    CallEMS --> HomeSafety["Nā ʻanuʻu no ka mālama ʻana ma mua o ka haukapila:<br/>1. Mai hāʻawi i ka Aspirin a hiki i ka lolo CT e hoʻopau i ke koko<br/>2. E mālama i ka NPO (ʻaʻohe meaʻai, inu, a i ʻole nā ​​​​palapala waha)<br/>3. E kākau i ka manawa hoʻomaka pololei, ka lōʻihi, a me nā hemahema kikoʻī<br/>4. E nānā hou iā BE-FAST i kēlā me kēia 5-10 mau minuke no ka hoʻi hou ʻana"]

    HomeSafety --> RiskCheck{"Nānā Kiʻekiʻe-Risk ABCD2 & Vascular Red Flags:<br/>- Haʻinaʻōlelo a i ʻole nāwaliwali ʻaoʻao hoʻokahi?<br/>- Ua hala ka Episode >= 10 minuke?<br/>- He nui nā ʻāpana hope-a-hope ('Crescendo TIA')?<br/>- ʻIke ʻia ka atrial fibrillation ʻole, carotid ʻeha / ʻeha ma luna o hoʻokahi makahiki <br/60 makahiki. (Amaurosis Fugax)?"}

    RiskCheck -->|"ʻO kēlā me kēia manawa a maopopo ʻole paha"| HospitalWorkup["Hoʻomaʻamaʻa Halemaʻi Hoʻokahi hola:<br/>1. ʻO ke poʻo ʻokoʻa ʻole CT + CT Angiogram (Head & Neck)<br/>2. MRI (DWI)<br/>3. 12-Lead ECG & Telemetry no Atrial Fibrillation<br/>4. ʻO ka hoʻomaʻamaʻa ʻana o Dual Antiplatelet Therapy (DAPT) i ka wā i hoʻopau ʻia ai ke koko"]

He aha ka hana i loko o ka lolo i ka wā TIA (a no ke aha i hoʻololi ai ka wehewehe ʻana o ka hola 24 kahiko)¶

No nā makahiki he nui, ua hoʻohana nā puke kula lapaʻau i ka ** wehewehe i ka manawa ** no kahi TIA: kekahi hemahema neurological focal hikiwawe i emi iho ma mua o 24 hola. ʻO ka neuroimaging hou me Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) i hōʻoia i kēia wehewehe ʻana kahiko i alakaʻi hewa loa. Ua hōʻike nā haʻawina e ka American Heart Association (AHA) a me ka American Stroke Association (ASA) he 30 a 50 ka nui o nā maʻi i hoʻoholo ʻia nā hōʻailona maʻi i loko o 1 a i 24 mau hola he mau wahi microscopic o ka ʻiʻo lolo make ma kahi MRI scan **.

I kēia lā, hoʻohana ka AHA/ASA, European Stroke Organization (ESO), a me ka World Health Organization i ka ** wehewehe i hoʻokumu ʻia i ka ʻiʻo : - Transient Ischemic Attack (TIA): He hanana kuʻuna o ka maʻi neurological i hoʻokumu ʻia e ka lolo focal, spinal cord, a i ʻole retinal ischemia, me ka loaʻa ʻole o ka infarction (ka make mau ʻana o ke kino) ma ke kiʻi lolo. ʻO ka hapa nui o nā TIA ʻoiaʻiʻo wale nō 2 a 15 mau minuke; i ka manawa e lōʻihi ai ka hemahema ma mua o 60 mau minuke, emi iho ma mua o 15 pakeneka hoʻoholo i loko o 24 mau hola me ka waiho ʻole ʻana i kahi ʻili mau ma MRI. - No ke aha e hiki mai ai ka TIA: Wehe ʻia ka ʻaʻa koko a i ʻole ka cholesterol mai ke aʻa ʻāʻī haiki ( carotid a i ʻole vertebral artery stenosis**) a i ʻole ka puʻuwai (atrial fibrillation a i ʻole ka puʻuwai puʻuwai), a i ʻole he aʻaʻaʻa komo hohonu liʻiliʻi i loko o ka lolo a me nā plug (lacunar ischemia). No kekahi mau minuke, nalowale ke kahe o ke koko ma lalo o ka paepae hoʻoheheʻe uila (\(<20\text{mL/100g/min}\)) a hoʻōki i ke kī ʻana, e hōʻeha ana i ka maʻi lolo, ka helu, a me ka makapō. Ma mua o ka hele ʻana o ka ʻiʻo i ka paepae hiki ʻole ke hoʻihoʻi hou ʻia (\(<10\text{ mL/100g/min}\)), hoʻoheheʻe nā enzymes koko maoli i ka clot a i ʻole nā ​​​​aʻa koʻikoʻi e wehe, e hoʻihoʻi i ka hana. - No ke aha he 24 a 48 mau hola e hiki mai ana: ʻO ka maʻi ulcerated plaque paʻa ʻole i loko o ke aʻa o ka ʻāʻī a i ʻole ke keʻena hoʻoheheʻe i loko o ka puʻuwai nāna i kiʻi i kēlā "pana aʻe" mua e hoʻoheheʻe mau ana i nā ʻōpala. Me ka ʻole o ka hoʻopaʻa ʻana i ka lāʻau lapaʻau, ʻoi aku ka nui o ka clot hou i hoʻokuʻu ʻia i kekahi mau hola ma hope a hoʻoulu i kahi hahau mau loa.

Ke ʻike nei i nā hōʻailona TIA maʻamau a atypical¶

Ma muli o ka mālama ʻana o ka lolo i nā hana like ʻole ma waena o ʻekolu mau ʻāpana vascular nui, ʻaʻole like ka TIA me ke kiʻi kīwī maʻamau o kahi maka kulu a me ka lima lolo. E hoʻohana i ka māka BE-FAST i hoʻonui ʻia a ʻike i nā ʻano anatomical kikoʻī ʻekolu:

1. Anterior Circulation TIA (Internal Carotid & Middle Cerebral Artery Territory)¶

• Amaurosis Fugax ("Fleeting Blindness" in One Eye): ʻO ke aʻa ophthalmic ka lālā mua loa o ke aʻa carotid kūloko i loko o ka iwi poʻo. I ka wā e paʻi ai kahi aniani cholesterol (Hollenhorst plaque) a i ʻole platelet clot mai kahi aʻa carotid haiki ma ka ʻāʻī, pana pinepine ia i loko o ke aʻa retinal o kahi maka. Hōʻike ka poʻe maʻi i kahi "ʻeleʻele ʻeleʻele, pale hina, a i ʻole ka makapō Venetian e huki ana i lalo a i ʻole hoʻokahi maka" e lōʻihi ana 1 a 10 mau minuke a laila hoʻihoʻi i luna.
• Nawaliwali a i ʻole ʻAha Kūʻē Kūʻē: Nawaliwali hikiwawe, kaumaha, puʻupuʻu, a i ʻole ka make ʻana o ka ** alo, lima, a/a i ʻole wāwae ma ka ʻaoʻao ʻē aʻe o ke kino** (no ka laʻana, ʻo ka TIA carotid artery hema ke kumu e hāʻule ai ka ʻaoʻao ʻākau a nāwaliwali ka lima ʻākau).
• Aphasia a i ʻole Dysarthria (Language & Speech Loss): Inā pili ka hemisphere nui (kokoke i ka ʻaoʻao hema o ka lolo), hiki koke ke kanaka ke ʻōlelo, hoʻololi i nā huaʻōlelo hewa (word salad), a i ʻole hiki ke hoʻomaopopo i nā huaʻōlelo i ʻōlelo ʻia a i kākau ʻia (receptive aphasia), ʻoiai no 3 mau minuke wale nō.

2. Posterior Circulation TIA (Vertebrobasilar Territory, Hala pinepine i ka Triage)¶

Hāʻawi nā ʻaʻaʻa vertebral ʻelua a me ke aʻaʻa basilar i ka lolo, cerebellum, a me ka occipital visual lobes. Hoʻomaopopo pinepine ʻia nā TIA hope e like me ka vertigo pepeiao a i ʻole ka luhi: - Hemianopia Homonymous: Nalo koke ʻia ka hapa hema a i ʻole ka hapa ʻākau o ke kahua ʻike ma mau maka ʻelua i ka manawa like. - ** ʻO ka "5 Ds" o Brainstem Ischemia:** ʻO ** ʻOhi/Vertigo** (nā ʻano milo i hui pū ʻia me nā hōʻailona neurological ʻē aʻe), Diplopia (ʻike maka pālua i ka wā e wehe ʻia ai nā maka ʻelua), ** Dysarthria ** ('ōlelo slurred), ** Dysphagia ** (paʻakikī hikiwawe i ka ʻai ʻana), a me Dystaxia ihu pololei). - Nā ʻino ʻino i hala: ʻO ka helu ʻana ma kekahi ʻaoʻao o ka maka i hui pū ʻia me ka helu a nāwaliwali paha ma ka ʻaoʻao ʻē aʻe o ke kino.

3. Capsular Warning Syndrome ("Crescendo TIAs")¶

I ka capsular warning syndrome, ʻo ka paʻa ʻana o kahi ʻaʻaʻa liʻiliʻi liʻiliʻi (ʻo ka lālā lenticulostriate e hānai ana i ka capsule i loko, kahi e hui pū ai nā aʻalolo kaʻa holoʻokoʻa) ke kumu ** 3 a 10+ mau ʻāpana hope o ka lolo holoʻokoʻa o ka ʻaoʻao hoʻokahi o ka maka, lima, a me ka wāwae i loko o 12 a 24 hola**. Ma waena o nā ʻāpana, ʻano maʻamau ke kanaka no 20 mau minuke, a laila nalowale koke ka neʻe ʻana ma kekahi ʻaoʻao. ** A hiki i ka 40 pakeneka o nā maʻi me ka capsular warning syndrome e holomua ana i ka maʻi maʻi paʻa ʻole i loko o nā lā **, e koi koke ana i ke komo ʻana i ka ICU/Stroke Unit.

Hoʻohālikelike piha: TIA vs. Completed Stroke vs. Common TIA Mimics¶

Hoʻolālā nā kauka ulia pōpilikia i kekahi mau kūlana maikaʻi a weliweli ("TIA mimics") hiki ke hoʻohālikelike i kahi mini-stroke. E hoʻohālikelike i nā hiʻohiʻona ma lalo nei:

Ka helu ʻana i ka pilikia o ka hahau koke ʻana: ʻO ka ABCD2 Clinical Score¶

Hoʻohana nā keʻena ulia pōpilikia ma ka honua holoʻokoʻa i ka ** ABCD2 Score ** i hoʻopaʻa ʻia ma ka ʻaoʻao o ke kiʻi vascular e stratify pehea e loaʻa ai kahi maʻi TIA i kahi hahau piha i loko o 48 hola e hiki mai ana. ʻO ka hoʻomaopopo ʻana i kēia mau kumu ʻelima e hōʻike ana i ke kumu e mālama ai nā paramedics a me nā haukapila i kekahi mau TIA ma ke ʻano he ʻelima-alarm ulia pōpilikia:

He aha ke ʻano o ka huina ABCD2 (0 a 7 mau helu):¶

• Ka helu 0 a i ka 3 (Ka helu haʻahaʻa, akā ʻaʻole i loaʻa i ka pilikia ʻole): ma kahi o \(1.0\text{ pākēneka}\) ka pilikia o ka hahau nui i loko o 48 hola. Ka ʻōlelo aʻo koʻikoʻi mai NICE (UK) a me AHA/ASA: ʻO ka mea maʻi me ka helu ABCD2 o \(0\text{ a i ʻole }1\) hiki ke loaʻa iā 90 pākēneka i hoʻopaʻa ʻia i ke aʻa carotid (no ka laʻana, he 55-makahiki maʻi maʻi maʻi ʻole me kahi manawa 3 mau minuke o ka makapō maka hoʻokahi mai ka *amaurosis fugax2 mau helu he $0 ma ke kaʻina ABC. No laila, paipai nā alakaʻi o kēia wā ** i ka lā hoʻokahi neuroimaging a me ke kiʻi vascular no nā TIA a pau i manaʻo ʻia **, me ka ʻole o ka helu ABCD2.
• Ka helu 4 a hiki i ka 5 (Mederate-High Risk): \(4.1\text{ pakeneka}\) pilikia o ka hahau i loko o 48 hola; ka pahuhopu no ka hoʻokomo koke ʻana i ka haukapila a me ka ʻelua antiplatelet therapy (DAPT).
• Ka helu 6 a hiki i ka 7 (Loaʻa Loa): \(8.1+\text{ pākēneka}\) pilikia o ka hōʻeha ʻana i ka hahau ʻana i loko o 48 hola (a ʻoi aku ka kiʻekiʻe inā loaʻa ka carotid stenosis a i ʻole atrial fibrillation).

No ke aha ʻaʻole pono ʻoe e hāʻawi i ka aspirin ma ka home ma mua o ka CT scan lolo: ʻO ka "Amyloid Spell" Trap¶

ʻO kahi nīnau maʻamau mai nā ʻohana: *"Inā loaʻa kahi TIA ma kahi ʻāpana liʻiliʻi, ʻaʻole anei mākou e hāʻawi i kahi papa aspirin 300 mg i kēia manawa ma ka home?" i kēlā me kēia manawa e loaʻa ai ka halihali ulia pōpilikia, no nā kumu hoʻopakele ola ʻelua:

1. Transient Focal Neurological Episodes ("Amyloid Spells"): I ka poʻe makua ma luna o 60 makahiki, he maʻi i kapa ʻia ʻo Cerebral Amyloid Angiopathy (CAA) ka mea e maʻalahi ai nā aʻa koko liʻiliʻi ma ka ʻili o waho o ka lolo. Ke hoʻoheheʻe kekahi o kēia mau moku ʻili i kahi kulu liʻiliʻi o ke koko i loko o nā awāwa o ka lolo (convexity subarachnoid hemorrhage a i ʻole cortical superficial siderosis), hoʻonāukiuki ia i ka sensory a i ʻole motor cortex, e hoʻoulu ai i kahi hanana 5-a-15-minuke o ka hoʻolaha ʻana i ka numbness, tingling, a i ʻole nāwaliwali ma kekahi lima a me kahi alo e like me ka TIA. ʻO ka hāʻawi ʻana i ka aspirin a i ʻole clopidogrel i ka mea maʻi me ka "amyloid spell" hiki ke hoʻoulu i ka hemorrhage lolo lobar nui i loko o nā hola.
2. Evolving Hemorrhagic Stroke: Hiki ke hoʻomaka ke koko liʻiliʻi i loko o ka cerebral i kekahi manawa me nā hōʻailona haʻalulu ma mua o ka hoʻonui ʻana. ʻO ke poʻo ʻokoʻa ʻole CT scan i loko o ka lumi pilikia e emi iho ma mua o 5 mau minuke a hōʻoia koke inā aia ke koko.

He aha ka mea i loko o ka 'Oihana Hoʻopilikia: Pehea e pale ai ka mālama haukapila i ka 80% o nā hahau¶

ʻO ka hoʻomaopopo ʻana i nā pou ʻehā o kahi hana TIA o ka haukapila pilikia e wehewehe i ke kumu he mea weliweli loa ke kali ʻana i ʻelua lā no kahi kipa keʻena maʻi ma waho:

1. Kiʻi Kiʻi ʻAi ʻAi a me ka lolo (CT, CTA, a me DWI-MRI)¶

• Non-Contrast Head CT: Hoʻoholo i ka hemorrhage lolo nui a i ʻole ka lolo lolo i nā minuke.
• CT Angiography (CTA) o ke poʻo a me ka ʻāʻī (a i ʻole Carotid Duplex Ultrasound): Hoʻopalapala i nā ʻaʻa mai ka ʻāʻī aortic a hiki i ka ʻāʻī (carotid and vertebral arteries) a i loko o ka lolo (Circle of Willis).
• No ke aha ʻaʻole hiki ke kali: Inā hōʻike ʻo CTA a i ʻole ultrasound symptomatic severe internal carotid artery stenosis (\(70\text{ a }99\text{ percent}\) narrowing, a i ʻole \(50\text{ to }69\text{ percent}\) i nā maʻi i koho ʻia) ma ka ʻaoʻao i hoʻokumu ʻia ai ka TIA, e hana nā kauka lapaʻau i kahi **Carotid Endarterectomy (surquedectomy) i loko o 48 hola a 14 lā. ʻO ka hana ʻana i ka ʻoki carotid i loko o nā lā mua ma hope o ka TIA e pale i nā hahau make; ʻO ka kali ʻana ma mua o kekahi mau pule e nalowale ka hapa nui o ka pōmaikaʻi pale no ka mea ua hiki mua ka hahau nui.

2. ʻO ka lāʻau lapaʻau ʻelua Antiplatelet Therapy (DAPT): ʻO ka CHANCE a me POINT Trial Protocol¶

I ka manawa e hoʻoholo ai ke poʻo o ke keʻena pilikia ʻo CT i ke kahe o ka lolo a ʻaʻole ka hana i kahi puʻuwai puʻuwai e koi ana i ka anticoagulation piha: - No nā poʻe maʻi me kahi ** TIA kiʻekiʻe loa ( ABCD2 score \(\ge 4\))** a i ʻole ischemic stroke liʻiliʻi i hiki mai i loko o 24 a 72 hola, hāʻawi koke nā kauka pilikia i kahi ** hoʻouka ʻana o ʻelua mau lāʻau antiplatelet hui pū (Dual Antiplatelet Therapy, a i ʻole DAPT): maʻamau aspirin me clopidogrel (a i ʻole INT, ** aspirin e pili ana i ka clopidogrel (a i ʻole CH, aspirin a me clopidogrel**) THALES, a me INSPIRES hoʻokolohua lapaʻau) no ka puka makani pōkole o 21 lā, a ukali ʻia e ka lāʻau lapaʻau hoʻokahi-agent no ka wā lōʻihi. - ʻO ka hoʻomaka ʻana i ka DAPT i loko o nā hola 24 mua e ʻoki i ka pilikia o kahi hahau nui i nā pule mua i hoʻohālikelike ʻia me ka aspirin wale nō, me ka pōmaikaʻi nui loa i loaʻa i ka mua 24 a 72 hola.

3. Ka nānā 'ana i ke kani o ka na'au no ka Fibrillation Atrial Huna¶

Ma kahi o 1 i loko o 5 ischemic strokes a me TIAs ma muli o ke koko i hoʻokuʻu ʻia mai ka ʻaoʻao hema o ka puʻuwai ma muli o Atrial Fibrillation (AFib), he puʻuwai kū ʻole e hele pinepine a hele mālie (paroxysmal atrial fibrillation). - Inā hoʻokumu ʻia kahi TIA e ka atrial fibrillation, ʻaʻole kūpono ka aspirin maʻamau; akā, pono ka mea maʻi i kahi ** anticoagulant waha** (e like me apixaban, rivaroxaban, dabigatran, edoxaban, a i ʻole warfarin), e hōʻemi ana i ka pilikia o ka hahau ʻana ma kahi o 65 a 70 pakeneka. - Hana ka hui ulia pōpilikia i kahi ECG 12-lead, telemetry puʻuwai hoʻomau mau, kahi echocardiogram, a hoʻouna pinepine i ka mea maʻi i ka home me kahi mea nānā puʻuwai puʻuwai a i ʻole implantable loop recorder.

4. ʻO ka Statin Plaque Stabilization kiʻekiʻe a me ka hoʻomalu ʻana i ke koko¶

Hoʻomaka koke nā kauka ulia pōpilikia i ka ikaika nui statin therapy (e like me ka atorvastatin a i ʻole rosuvastatin) e hoʻopaʻa i nā plaque arterial inflamed a hoʻomaha i ka ʻili o ka moku, me ka mālama ʻana i ke koko no ka manawa lōʻihi.

ʻO ka mālama mua ʻana o ka haukapila i ka wā e kali ana i ka ambulance¶

1. E hoʻonoho i ke kanaka me ka palekana a pāpā i ke kaʻa ʻana:
2. E noho ke kanaka ma kahi noho kākoʻo a moe paha ma luna o kahi moe a moe paha me ke poʻo a me nā poʻohiwi i hoʻopaʻa ʻia ma kahi **30-degere **.
3. Mai ʻae i ka mea i loaʻa iā ia ka TIA e hoʻokele iā ia iho i ka haukapila a i ʻole ka mālama koʻikoʻi. ʻO ka lua o ka TIA a i ʻole ka hahau piha ʻana e hahau pinepine i 15 mau minuke ma hope o ka mua ʻoiai aia ke kanaka ma hope o ka huila ma ke alaloa.
4. E hana a kākau i lalo i kahi helu 6-helu BE-FAST nānā:
5. B (Balance): Hiki iā lākou ke kū a hele wāwae paha i ka wā o ka hanana, a pehea ko lākou kaulike i kēia manawa?
6. E (Eyes): Ua nalowale paha ka ʻike ma ka maka hoʻokahi ("ka pale e iho ana") a i ʻole ʻike pālua? E nānā i nā maka ʻelua i kēia manawa.
7. F (Face): E noi iā lākou e ʻakaʻaka nui a hōʻike i ko lākou mau niho. Ua hāʻule mua paha kekahi kihi o ka waha? He symmetric i kēia manawa?
8. A (Nā lima a me nā wāwae): E noi iā lākou e pani i ko lākou mau maka a hoʻopaʻa pololei i nā lima ʻelua i mua me ke alo i luna no 10 kekona. E nānā i ka neʻe ʻana o kekahi lima i lalo a i ʻole ka ʻōwili i loko (pronator drift).
9. S (Speech): E noi iā lākou e haʻi hou: "ʻAʻole hiki iā ʻoe ke aʻo i kahi ʻīlio kahiko i nā hana hoʻopunipuni hou" a i ʻole "He polū ka lani ma Lākana." E nānā i nā consonants slurred a i ʻole ka ʻimi huaʻōlelo.
10. T (Loaʻa Manawa): Kākau i lalo i ka manawa o ka uaki pololei i hoʻomaka ai ka manawa a me ka manawa i hoʻoholo ʻia ai.
11. E hoʻopaʻa i kahi wikiō 30-kekona inā e hoʻihoʻi pōkole kekahi hōʻailona:
12. Inā ʻike hou ʻia ka maka o ke kanaka, ka ʻāʻī lima, a i ʻole ka haʻi ʻōlelo slurred no 60 kekona i ka wā e kali ana i ka paramedics, loaʻa i kahi mea e hopu ai i kahi wikiō kelepona 15-kekona (me ka ʻole o ka hoʻopaneʻe ʻana) hāʻawi i ka neurologist o ka haukapila i hōʻike ʻike ʻole ʻia o ka ʻāina vascular pololei.
13. E nānā i ka glucose koko capillary (inā loaʻa kahi glucometer):
14. Inā lawe ke kanaka i ka insulin a i ʻole sulfonylurea i nā lāʻau maʻi diabetes, e kui i ka manamana lima e nānā i ke kō koko. Hypoglycemia (\(<3.9\text{ mmol/L}\) a i ʻole \(<70\text{ mg/dL}\)) hiki ke hoʻoulu koke i ka nāwaliwali a me ka huikau (hypoglycemic hemiparesis) i nalo ke hoʻihoʻi ʻia ke kō koko. ʻOiai inā loaʻa a mālama ʻia ke kō koko haʻahaʻa (e nānā ulia pōpilikia), loaʻa i nā paramedics e loiloi i ka mea maʻi.

Palapala kamaʻilio pololei no 911 / 112 / 999 a me Emergency Triage¶

Ma muli o ka nānā pinepine ʻana o ka mea maʻi TIA i ke olakino maikaʻi loa i ka wā e hele ai nā paramedics ma ka puka mua a i ʻole ke piʻi ʻana i kahi puka hoʻāʻo o ka lumi pilikia, ** pehea ʻoe e wehewehe ai i ka hanana e hoʻoholo inā ʻike koke ʻia lākou a kali paha i nā hola i loko o kahi lumi kali**. E hoʻohana i kēia palapala kikoʻī kikoʻī:

• I ke kelepona ʻana iā 911 / 112 / 999:

  *"Pono au i kahi kaʻa kaʻa ma [Exact Address] no kahi mea i manaʻo ʻia ʻo Transient Ischemic Attack a i ʻole evolving stroke. I ka [Exact Start Time], ua ulu koke kēia [Male/female] makahiki [kane/female] [māka ʻākau / hema / ʻākau / lima hema nāwaliwali / hiki ʻole ke kamaʻilio / kahi pale pōʻeleʻele ma luna o ka [X] mau minuke no ka hoʻoholo ʻana. Loaʻa iā [ia] kahi moʻolelo o [ke koko kiʻekiʻe / diabetes / atrial fibrillation / paka].

• I ke kamaʻilio ʻana me ke Keʻena ʻOihana Hoʻomaʻamaʻa Triage Nurse (inā aia i ka haukapila):

  "Pono mākou i ka loiloi TIA / Acute Stroke Triage. He kanakolu mau minuke i hala aku nei i [Time], ua hoʻomaka koke ʻia [e wehewehe pono i ka nāwaliwali o ka ʻaoʻao hoʻokahi, haʻi ʻōlelo, a i ʻole makapō hoʻokahi-maka] mau [X] mau minuke. Ma muli o ka makahiki, ke kahe koko, a me ka moto/ʻōlelo ʻōlelo, [ʻo kāna] ma ka liʻiliʻi loa, ʻo ia ka helu ABCD a me ka helu ABCD. pukaaniani 24-hola."

Ka papa helu hoʻomākaukau o ka haukapila ma mua o ka haʻalele ʻana o ke kaʻa kaʻa¶

• Ka manawa hoʻomaka pololei a me ka manawa hoʻoholo i kākau ʻia ma ka pepa.
• Papa piha o nā lāʻau lapaʻau o kēia manawa (ʻoi aku ka ʻoi aku o nā mea hoʻokahe koko e like me warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, a i ʻole aspirin, me ka manawa pololei i ʻai ʻia ai ka maʻa hope loa).
• Ka helu kelepona o ka mea ʻike maka i ʻike i nā hōʻailona (inā ʻaʻole e holo ana ka mea hōʻike ma ke kaʻa kaʻa, e kelepona koke ka neurologist iā lākou e hōʻoia i ke ʻano o ka hanana).
• Kaleka implant maʻi (pacemaker, defibrillator, heart valve, a i ʻole coronary stents, no laila ʻike ka haukapila inā hiki i ka mea maʻi ke hele pololei i ka MRI scanner).

Nīnau pinepine¶

Inā nalowale loa koʻu mau hōʻailona maʻi maʻi i loko o 10 mau minuke, no ke aha e hiki ʻole ai iaʻu ke hoʻonohonoho i kahi manawa me koʻu kauka ʻohana i kēia pule aʻe?¶

ʻO ka transient ischemic attack (TIA) he hōʻailona hōʻailona ia e hoʻoheheʻe ikaika ana kahi plaque arterial paʻa ʻole ma kou ʻāʻī a i ʻole kahi kumu koko i loko o kou puʻuwai. Ma kahi kokoke i ka hapalua o nā hahau nui a pau e hoʻopau ana i ka TIA i loko o nā hola 24 a 48 mua; ʻO ka hele ʻana i ke keʻena pilikia e ʻae koke i nā kauka e nānā i kou lolo a me kou ʻāʻī ʻāʻī, ʻike i ka fibrillation atrial, a hoʻomaka i ka lāʻau antiplatelet a i ʻole anticoagulant ʻelua i ka lā hoʻokahi, e ʻoki ana i kou pilikia i ka hahau ʻana a hiki i ka 80 pakeneka.

He aha ka "amaurosis fugax," a no ke aha i mālama ʻia ai ka nalo ʻana o ka maka ma ka maka hoʻokahi ma ke ʻano he mini-stroke?¶

ʻO Amaurosis fugax (Helene no ka "pōʻeleʻele holoʻokoʻa") kahi nalo ʻole o ka ʻike ma ka maka hoʻokahi, i wehewehe pinepine ʻia he pale ʻeleʻele a i ʻole ka malu e huki ana i lalo o ka maka no kekahi mau minuke ma mua o ka hāpai ʻana. No ka mea ʻo ke aʻa ophthalmic e hānai ana i ka retina ʻo ia ka lālā mua o ke aʻa carotid kūloko ma ka ʻāʻī, ʻo ka ʻeleʻele pōkole ma ka maka hoʻokahi he hōʻailona hōʻailona maʻamau o ke aʻaʻa carotid koʻikoʻi e hiki ke hoʻoulu i ka hemisphere nui i loko o nā hola a i ʻole mau lā.

No ke aha e ʻōlelo ai nā alakaʻi pilikia e kali i kahi CT scan ma mua o ka lawe ʻana i ka aspirin ma hope o kahi TIA i manaʻo ʻia?¶

ʻOiai e hoʻomaka koke ʻia ka aspirin a me ka clopidogrel i ka haukapila i ka manawa e hōʻoia ai ka CT scan ʻaʻohe koko, ʻo ke koko liʻiliʻi o ka lolo (e like me ka cerebral amyloid angiopathy spells i ka poʻe ʻelemakule) hiki ke hoʻoulu i nā manawa 5-a-15 mau minuke o ka hoʻolaha ʻana i ka numbness a i ʻole nāwaliwali e like me ka TIA. ʻO ka lawe ʻana i ka aspirin ma ka home ma mua o 5 mau minuke o ke poʻo o ka haukapila CT scan e hoʻoholo i ke koko e hiki ke hoʻohuli i kahi leak cortical liʻiliʻi i loko o ka hemorrhage lolo.

Hiki i kahi TIA ke waiho i ka pōʻino mau loa ma ka lolo ma muli o ka manaʻo o ke kanaka he 100 pakeneka hoʻi i ka maʻamau?¶

ʻAe, ʻo nā noiʻi lāʻau lapaʻau me ka hoʻohana ʻana i ka Diffusion-Weighted MRI (DWI) kiʻekiʻe e hōʻike ana a hiki i ka hapakolu o nā maʻi i hoʻopau piha ʻia nā hōʻailona hōʻeha i loko o nā minuke a hiki i hoʻokahi hola he wahi liʻiliʻi o ka infarction o ka lolo mau loa i kā lākou MRI scan, e hōʻoia ana i ka pili ʻana o ka lolo i kahi hahau pōʻino a hōʻike i ka wikiwiki o ka mālama haukapila koke.

Nānā ʻia nā kumu¶

• **ʻAhahui Puʻuwai ʻAmelika (AHA) a me ʻAhahui ʻAmelika Hui Pū ʻIa (ASA, ʻAmelika Hui Pū ʻIa): ** * Nā alakaʻi no ka pale ʻana i ka maʻi maʻi i nā maʻi me ka maʻi a me ka hoʻouka ʻana i ka maʻi maʻi maʻi * (Stroke, Kleindorfer et al.) a me * Ka wehewehe ʻana a me ka loiloi o Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Stroke and Transient Ischemic Attack in Over 16s: Diagnosis and Initial Management (NICE Guideline NG128, hōʻike loea kūikawā a me nā protocol imaging).
• European Stroke Organization (ESO): Alakaʻi no ka mālama ʻana i ka Transient Ischemic Attack (European Stroke Journal, Fonseca et al., me nā ʻōlelo paipai ʻelua antiplatelet therapy [DAPT] mai nā hoʻokolohua CHANCE, POINT, a me THALES).
• Nā Manaʻo Hoʻomaʻamaʻa ʻoi loa i ka Stroke Canadian (Heart and Stroke Foundation of Canada): Ke Kāohi ʻelua o ka Stroke a me Transient Ischemic Attack Triage a me nā alakaʻi alakaʻi hoʻokele pilikia.
• World Health Organization (WHO) & World Stroke Organization (WSO): Global Stroke Guidelines and Action Plan for Acute Cerebrovascular Triage.

Nā alakaʻi pili¶

• ʻO ka ʻike ʻana i ka hahau (FAST) a me ka pane ulia pōpilikia
• ʻO ka maʻi lolo: ka hoʻokaʻawale ʻana i ka maʻi lolo ʻo Bell mai ka maʻi lolo
• Subarachnoid hemorrhage, hekili po'o, a ruptured brain aneurysm
• ʻO ke kiʻekiʻe kiʻekiʻe a me ka wikiwiki: ke piʻi ke koko ma mua o 180/120
• ʻO nā pilikia maʻi diabetes: hypoglycemia a me hyperglycemia kōkua mua