Uhlaselo lwe-Ischemic oluThutyanayo (TIA / i-Mini-Stroke) kunye noThintelo lwe-Stroke olukhawulezileyo¶

Uhlaselo lwe-ischemic oludlulayo (TIA), oludla ngokubizwa ngokuba yi--mini-stroke okanye i-warning stroke, lwenzeka xa ihlwili legazi okanye i-plaque fragment ivalela okwethutyana umthambo onika ingqondo okanye iliso, okubangela ukuba ngesiquphe iimpawu ze-stroke zibonakale ziphela ngokupheleleyo kwimizuzu ukuya kwiyure. Ngenxa yokuba ihlwili liqhekeka okanye lizinyibilike lodwa ngaphambi kokuba libangele ukufa kweeseli zengqondo, abantu abaninzi benza impazamo ebulalayo yokubuyela ebhedini okanye balinde iintsuku ezimbalwa ukuba babize ugqirha wabo wosapho. Enyanisweni, i-TIA yimeko engxamisekileyo yonyango: ** ukuya kwi-10 ukuya kwi-15 ipesenti yabantu abahlukunyezwa yi-TIA baya kuba ne-stroke enkulu yokukhubaza okanye ebulalayo phakathi kweentsuku ze-90 ezizayo, kwaye phantse isiqingatha saloo mivimbo eyingozi kwiiyure zokuqala ze-24 kwiiyure ze-48 **. Uvavanyo olukhawulezileyo lwesibhedlele ngosuku olufanayo lunciphisa ingozi ye-stroke kwangoko ukuya kuma-80 ekhulwini.

Yenza oku ngoku¶

1. Fowunela inombolo yakho kaxakeka yasekuhlaleni ngokukhawuleza, nokuba zonke iimpawu zisonjululwe ngokupheleleyo. Cofa u-911 eUnited States naseKhanada, 112 ngapha kweEuropean Union, 999 eUnited Kingdom, okanye ujonge zonke amanani kaxakeka. Xela ngokucacileyo i-dispatcher: * "Isigulana sibe neempawu ze-stroke ngokukhawuleza ezithatha [X] imizuzu kwaye zinokuba ne-Transient Ischemic Attack okanye i-stroke eguqukayo." * Cela ukuthutha kwiZiko le-Stroke eliqinisekisiweyo.
2. Bhala phantsi umzuzu ochanekileyo iimpawu ziqalile ("Ixesha lokugqibela elaziwa kakuhle") kunye nomzuzu ochanekileyo abaye bayeka. Iingcali ze-Emergency neurologists zithembele kwiwotshi yokuqala kunye nobude bexesha lokubala umngcipheko we-stroke weyure ezingama-24 kunye nokugqiba ukufaneleka kwonyango lwe-clot-busting (thrombolysis) ukuba iimpawu zibuyele ngokukhawuleza ngelixa i-ambulensi ibuyele ngokukhawuleza.
3. Musa ukunika i-aspirin, i-clopidogrel, i-ibuprofen, okanye nayiphi na i-blood thinner de i-CT scan yesibhedlele ikhuphe ukopha kobuchopho. Ngelixa unyango lwe-antiplatelet kabini (i-aspirin kunye ne-clopidogrel okanye i-ticagrelor) luqalwa kwisebe likaxakeka ngokukhawuleza emva kwe-neuroimaging, ukuthatha i-aspirin ekhaya phambi kokuba intloko ye-CT scan iyingozi ngenxa yokuba iimpawu ze-hemorrhagic stroke, i-transmient neurological.
4. Gcina umntu ngokungqongqo kungekho nto ngomlomo (NPO) kwaye ehleli okanye elele ngokukhululekileyo ngentloko yakhe kwii-degrees ezingama-30. Musa ukunika ukutya, amanzi, okanye iipilisi zomlomo, njengoko i-ischemia ye-brainstem edlulayo idla ngokuyonakalisa i-gag kunye nokuginya i-reflexes ngaphandle kweempawu ezicacileyo zangaphandle, ukudala umngcipheko omkhulu wokuminxeka okanye i-aspiration pneumonia.
5. *Yenza ngokuphindaphindiweyo i-BE-FAST isheke ye-neurological yonke i-5 kwimizuzu ye-10 ngelixa ulinde i-paramedics. * Jonga ngokukhawuleza ** crescendo TIAs ** (ebizwa ngokuba yi-**capsular warning syndrome **), apho iimpawu ziza kwaye zihamba ngokuphindaphindiweyo ngaphezu kweyure ngaphambi kokuba uvale ukukhubazeka okusisigxina. Ukuba iimpawu ziyabuya, lumkisa ngeenkonzo zikaxakeka eziguqulelwe yi-TIA zibe zisebenzayo istroke.
6. Jonga iswekile esegazini ukuba umntu lowo unesifo seswekile, kwaye ulinganise isigqi sokubetha kwentliziyo kunye noxinzelelo lwegazi ukuba isixhobo sikufuphi. Ukwehla kakhulu kweswekile yegazi (iimeko ezingxamisekileyo zesifo seswekile eneglucose engaphantsi kwe \(3.9\text{mmol/L}\) okanye \(70\text{mg/dL}\)) inokulinganisa iTIA ngokufanayo. Ukuba une-pulse oximeter okanye i-blood pressure cuff, qaphela ukuba i-pulse ayifani (umkhondo ku atrial fibrillation) kwaye ubhale phantsi uxinzelelo lwegazi ngaphandle kokuzama ukuhlisa ekhaya.

Uvavanyo olungxamisekileyo kunye nomthi wesigqibo sovavanyo lwe-TIA¶

Sebenzisa le tshati yezonyango ukuphendula xa umntu esiva ngesiquphe iimpawu zemithambo-luvo okanye ezibonwayo, nokuba ezo mpawu zisekhona okanye sele zicinywe ngokupheleleyo.

flowchart TD
    Start["Ngesiquphe iNeurological or Visual Episode:<br/>Ukulahlekelwa kwibhalansi, ubumfama bamehlo/ukubona kabini,<br/>Ubuso buthontsizekile, ubuthathaka bengalo/umlenze okanye ukuba ndindisholo,<br/>Ukubhideka kwentetho okanye ukubhideka kwegama"] --> ActiveCheck{"NGABA NAziphi na iimpawu<br/>ezisekhoyo ngoku?"}

    ActiveCheck -->|"EWE: Kwanobunzima obuphakathi okanye unqumamo lokufumana amagama"| ActiveStroke["IKHOWUDI YE-STROKE ESEBENZAYO (Jonga iSikhokelo seStroke):<br/>1. Fowunela u-911/112/999 Ngoko nangoko<br/>2. Rekhoda kanye ixesha 'Elokugqibela Ukwaziwa Kakuhle'<br/>3. Gcina iNPO; MUSA ukunika i-aspirin phambi kwe-CT scan<br/>4. Ukuphuthuma kwi-Thrombectomy / i-Thrombolysis Centre"]

    ActiveCheck -->|"HAYI: Iimpawu zisonjululwe i-100% emva kwesiseko"| SuspectTIA["OKUrhanelekayo kuhlaselo lwe-ISCHEMIC OLUTHUTYANAYO (TIA)<br/>(I-Peak 24-to-48-Hour Major Stroke Window)"]

    SuspectTIA --> CallEMS["Tsalela umnxeba ku-911 / 112 / 999 Ngoko nangoko:<br/> Sukulinda idinga lekliniki ngomso.<br/>USUKUMvumela isigulana siziqhubele."]

    CallEMS --> HomeSafety["Amanyathelo oKhuseleko lweSibhedlele:<br/>1. MUSA ukunika iAspirin de ingqondo i-CT ikhuphe ukopha<br/>2. Gcina i-NPO (akukho kutya, siselo, okanye iipilisi zomlomo)<br/>3. Bhala kanye ixesha lokuqala, ubude, kunye neziphene ezithile<br/>4. Phinda ujonge i-BE-FAST rhoqo kwi-5-10 imizuzu yokuphinda ubuyele"]

    HomeSafety --> RiskCheck{"Khangela i-High-Risk ABCD2 kunye ne-Vascular Red Flags:<br/>- Ukuphazamiseka kwentetho okanye ubuthathaka obunye icala?<br/>- Isiqendu sahlala >= imizuzu eyi-10?<br/>- Iziqendu ezininzi ze-back-to-back ('Crescendo TIA')? umkhusane phezu kweliso elinye (Amaurosis Fugax)?"}

    RiskCheck -->|"Nayiphi na into ekhoyo okanye engaqinisekanga"| HospitalWorkup["Ukusebenza Kwangoko Ngeyure enye eSibhedlele:<br/>1. Intloko engafaniyo ne-CT + CT Angiogram (iNtloko kunye neNtamo)<br/>2. I-Diffusion-Weighted Brain MRI (DWI)<br/>3. I-12-Lead ECG kunye neTelemetry ye-Atrial Fibrillation<br/>4. Immediate Dual Antiplatelet Therapy (DAPT) xa ukopha kwalawula"]

Kwenzeka ntoni ngaphakathi kwengqondo ngexesha le-TIA (kwaye kutheni inkcazo yakudala yeeyure ezingama-24 itshintshile)¶

Kangangamashumi eminyaka, iincwadi zezifundo zonyango zisebenzisa i-arbitrary inkcazo esekelwe kwixesha ye-TIA: nayiphi na i-neurological deficit yequbuliso ehlala ingaphantsi kweeyure ezingama-24. I-neuroimaging yanamhlanje ene- Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) ibonise ukuba le nkcazo yakudala yayilahlekisa ngokuyingozi. Uphononongo olwenziwe yi-American Heart Association (AHA) kunye ne-American Stroke Association (ASA) ibonise ukuba ** i-30 ukuya kwi-50 ipesenti yezigulane ezineempawu ze-stroke ezixazulula kwiiyure ze-1 ukuya kwii-24 ngokwenene zineendawo ezisisigxina, ezincinci zezicubu zengqondo ezifileyo kwi-MRI scan **.

Namhlanje, i-AHA/ASA, i-European Stroke Organisation (ESO), kunye noMbutho wezeMpilo weHlabathi zisebenzisa i-inkcazelo esekwe kwi-tissue yanamhlanje: - I-Transient Ischemic Attack (TIA): Isiqendu sexeshana sokungasebenzi kakuhle kwe-neurological okubangelwa yi-focal brain, intambo yomgogodla, okanye i-ischemia ye-retinal, ** ngaphandle kwe-acute infarction (ukufa kwezicubu ezisisigxina) kwi-brain imaging **. Uninzi lwee-TIA eziyinyaniso zihlala kuphela 2 ukuya kwimizuzu eyi-15; kanye ukuba intsilelo ihlala ixesha elide kunemizuzu engama-60, ngaphantsi kweepesenti ze-15 isisombululo kwiiyure ze-24 ngaphandle kokushiya isilonda esisisigxina kwi-MRI. - Kutheni i-TIA isenzeka: Ihlwili okanye ikristale ye-cholesterol igqabhuka ikhulule nokuba kukwimithambo yentamo emxinwa (internal carotid okanye i-vertebral artery stenosis) okanye intliziyo (atrial fibrillation okanye ivalve yentliziyo), okanye umthambo omncinci ongene nzulu kwi-brain spasms kunye neeplugs (miacuna). Kwimizuzu embalwa, i-neuron esezantsi ilahlekelwa ukuhambawegazi ngaphantsi komda wokungaphumeleli kombane (\(<20\text{mL/100g/min}\)) kwaye iyeke ukudubula, okubangela ukukhubazeka, ukuba ndindisholo, okanye ukungaboni. Ngaphambi kokuba i-tissue iwele i-cell-death threshold engenakubuyiselwa (\(<10\text{mL/100g/min}\)), ii-enzyme zegazi zendalo zinyibilikisa ihlwili okanye imithambo ebambekayo evulayo, ibuyisela umsebenzi. - Kutheni iiyure ezizayo ezingama-24 ukuya kwezingama-48 zibalulekile: Iplayikhi enezilonda engazinzanga kumthambo wentamo okanye igumbi elenza ihlwili entliziyweni elithe ladubula “imbumbulu yesilumkiso” sokuqala lisaphalaza amahlwili. Ngaphandle kokuzinziswa kwangoko kwezonyango, ihlwili elilandelayo eliqaliswe kwiiyure ezimbalwa kamva lidla ngokuba likhulu kwaye libangela i-stroke esisigxina, etshabalalisayo.

Ukuqaphela iimpawu ze-TIA zakudala kunye ne-atypical¶

Ngenxa yokuba ingqondo ilawula imisebenzi eyahlukeneyo kwimimandla emithathu emikhulu yemithambo, i-TIA ayisoloko ijongeka njengomfanekiso kamabonwakude weklasi yobuso obujingayo kunye nengalo ekhubazekileyo. Sebenzisa eyandisiweyo BE-FAST khangela kwaye uqaphele iipateni ezintathu ze-anatomical:

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

• I-Amaurosis Fugax ("I-Fleeting Blindness" kwiLiso elinye): Umthambo wamehlo lisebe lokuqala kakhulu eliphuma kumthambo ongaphakathi wecarotid ngaphakathi kukhakhayi. Xa ikristale yecholesterol (Hollenhorst plaque) okanye ihlwili leplatelet lisuka kumthambo wecarotid ocuthekileyo osentanyeni, lihlala lidubula ngqo kumthambo we-retinal iliso elinye. Izigulana zichaza ngesiquphe, ezingenabuhlungu ngokupheleleyo "umthunzi omnyama, umkhusane ongwevu, okanye ukutsalwa kwemfama kwaseVenice okanye ukuwela iliso elinye" ethatha i-1 ukuya kwimizuzu eyi-10 ize iphinde iphakamisele phezulu.
• Ubuthathaka obuchaseneyo okanye ubundindisholo: Ubuthathaka ngequbuliso, ubunzima, ukuba buthathaka, okanye ukuba ndindisholo okufileyo kobuso, ingalo, kunye/okanye umlenze kwelinye icala lomzimba (umzekelo, umthambo wecarotid wasekhohlo iTIA ibangela ukuthotywa kobuso kwicala lasekunene kunye nobuthathaka besandla sasekunene).
• ** I-Aphasia okanye i-Dysarthria (uLwimi kunye noLahleko lweNtetho): ** Ukuba i-hemisphere elawulayo (phantse isoloko isecaleni lengqondo yengqondo) ichaphazeleka, umntu usenokungakwazi ukuthetha ngokukhawuleza, athathe indawo yamagama angalunganga (**isaladi yegama **), okanye angakwazi ukuqonda amagama athethiweyo okanye abhaliweyo (**i-aphasia eyamkelayo **), nokuba yimizuzu eyi-3 nje.

2. I-Posterior Circulation TIA (i-Vertebrobasilar Territory, edla ngokuphoswa kwi-Triage)¶

Imithambo emibini ye-vertebral kunye ne-basilar artery ibonelela nge-brainstem, i-cerebellum, kunye ne-occipital visual lobes. Ii-TIA ezingasemva zihlala zifunyaniswa gwenxa njenge-vertigo yangaphakathi okanye ukudinwa: - I-Homonymous Hemianopia: Ukulahleka ngequbuliso kwesiqingatha sasekhohlo okanye isiqingatha sasekunene sebala lokubonwayo ku amehlo omabini ngaxeshanye. - I-"5 Ds" ye-Brainstem Ischemia: Ngesiquphe Isiyezi/Vertigo (imvakalelo yokujikeleza edityaniswe nezinye iimpawu ze-neurological), Diplopia (umbono ophindwe kabini ngequbuliso xa amehlo omabini evulekile), Dysarthria (intetho engaqondakaliyo), Dysphagia (ubunzima bokugwinya ngequbuliso** okanye ukunyathela ngokukhawuleza), kunye (ubunzima bokuginya ngesiquphe) okanye*** Ubunzima bokugwinya ngesiquphe) umnwe empumlweni ngokuchanekileyo). - Iintsilelo zeNeurological Crossed: Ukuba ndindisholo kwelinye icala lobuso kudityaniswe nokuba ndindisholo okanye ubuthathaka kwelinye icala lomzimba.

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

Kwi- ** i-capsular isilumkiso syndrome **, ukuvaleka okwethutyana komthambo omncinci omncinci wokungena (ngokuqhelekileyo isebe le-lenticulostriate elondla i-capsule yangaphakathi, apho yonke imicu ye-motor nerve fibers idibanisa ngokuqinileyo) ibangela ** i-3 ukuya kwi-10 + i-back-to-back episodes epheleleyo yokukhubazeka kwecala elinye lobuso, ingalo, kunye nomlenze phakathi kwe-12 kwiiyure ze-24 **. Phakathi kweziqendu, umntu ubonakala eqhelekile ngokupheleleyo kwimizuzu engama-20, emva koko ulahlekelwa ngokukhawuleza yonke intshukumo kwicala elinye kwakhona. **Ukufikelela kwiipesenti ze-40 zezigulane ezine-capsular isilumkiso syndrome ziqhubela phambili kwisigxina esisisigxina, sokukhubaza phakathi kweentsuku **, ukwenza i-ICU / i-Stroke Unit yokungeniswa ngokukhawuleza inyanzelekile.

Uthelekiso olubanzi: TIA vs. Completed Stroke vs. Common TIA Mimics¶

Oogqirha abangxamisekileyo bavavanya iimeko ezininzi ezinobungozi kunye nezinobungozi ("I-TIA mimics") enokulinganisa okwethutyana i-mini-stroke. Thelekisa ezi mpawu zingezantsi:

Ukubala umngcipheko we-stroke okhawulezileyo: I-ABCD2 Clinical Score¶

Amasebe angxamisekileyo kwihlabathi jikelele asebenzisa i-ABCD2 Score eqinisekisiweyo ecaleni kwe-vascular imaging ukucacisa ukuba isigulane se-TIA sinokuthi sihlaselwe yi-stroke epheleleyo kwiiyure ezilandelayo ze-*48 **. Ukuqonda ezi zinto zintlanu zibonisa ukuba kutheni i-paramedics kunye nezibhedlele ziphatha ii-TIA ezithile njengeemeko ezingxamisekileyo ze-alarm ezintlanu:

Lithetha ukuthini i-ABCD2 Score (0 ukuya kwi-7 Points):¶

• Amanqaku 0 ukuya 3 (Amanqaku aphantsi, kodwa UNGAZE zero Risk): roughly \(1.0\text{percent}\) ingozi yestrowuku enkulu ngaphakathi 48 iiyure. Isilumkiso esibalulekileyo esivela kwi-NICE (UK) kunye ne-AHA/ASA: Nokuba isigulane esinenqaku le-ABCD2 le-$ 0\text{ okanye} i-1 $ ingaba ne-*90 yeepesenti evaliweyo yomthambo we-carotid ** (umzekelo, i-55-year-old non-diabetic ene-3-minute ye-episode ye-eye blindness of one-eye blindness" kwi-CD * amaurosis 2 amanqaku kodwa i-CD ye-fuga idinga amanqaku e-CD * {0} i-fuga ye-CD utyando olungxamisekileyo lwecarotid). Ngoko ke, izikhokelo zanamhlanje zincoma ** i-neuroimaging yosuku olufanayo olungxamisekileyo kunye ne-vascular imaging KUZO ZONKE ii-TIA ezikrokrelekayo **, kungakhathaliseki ukuba yintoni inqaku le-ABCD2.
• ** Amanqaku 4 ukuya 5 (Moderate-High Risk):** **\(4.1\text{pesenti}\) umngcipheko westroke kwiiyure ezingama-48 **; Ithagethi yokwamkelwa esibhedlele kwangoko kunye nonyango lwe-antiplatelet kabini (DAPT).
• ** Inqaku le-6 ukuya kwi-7 (iMngcipheko omkhulu): ** ** $ 8.1 +\text{ ipesenti} i-$ ingozi yokukhubaza i-stroke kwiiyure ze-48 ** (kwaye nangaphezulu ukuba i-carotid stenosis okanye i-fibrillation ye-atrial ikhona).

Kutheni UNGAFUNEKI unike i-aspirin ekhaya phambi kokuba ucinge nge-CT scan: I-"Amyloid Spell" Trap¶

Umbuzo oqhelekileyo ovela kwiintsapho uthi: * "Ukuba i-TIA ibangelwa yi-clot encinci, akufanele sinikeze i-tablet ye-aspirin ye-300 mg kwangoko ekhaya?" * Izikhokelo ze-neurology zanamhlanje (kubandakanywa ne- UK National Institute for Health and Care Excellence [NICE NG128] ** igubungela kunye ** i-AHA / ASA I-Acute Stroke Guidelines) (i-MRI i-Acute Stroke Guidelines) icebisa de i-CT ye-Stroke i-imaging) isebe phambi kokunika i-aspirin nanini na isithuthi esingxamisekileyo sifumaneka, ngezizathu ezibini ezisindisa ubomi:

1. I-Transient Focal Neurological Episodes ("Amyloid Spells"): Kubantu abadala abaneminyaka engaphezu kwama-60 ubudala, imeko ebizwa ngokuba yiCerebral Amyloid Angiopathy (CAA) yenza imithambo yegazi emincinane kumphezulu ongaphandle wobuchopho ibe buthathaka. Xa enye yale mikhumbi yomhlaba ivuza i-droplet encinci yegazi kwi-grooves yengqondo (**convexity subarachnoid hemorrhage ** okanye ** i-cortical superficial siderosis **), iyayicaphukisa i-sensory okanye i-motor cortex, ibangele isiqephu se-5-to-15-minute yokusabalalisa ukuphazamiseka, ukujongeka kwi-TIA kunye nobuso obuthambileyo. Ukunika i-aspirin okanye i-clopidogrel kwisigulana esine "amyloid spell" kunokubangela ukopha okukhulu, okubulalayo kwengqondo kwi-lobar kwiiyure nje ezimbalwa.
2. I-Evolving Stroke esophayo: Ukopha okuncinci okunzulu kwi-intracerebral ngamanye amaxesha kunokuqala ngokuba uthintitha okanye iimpawu ezingephi phambi kokuba kwandiswe. I-CT scan yentloko engahambelaniyo kwigumbi likaxakeka ithatha ngaphantsi kwemizuzu emi-5 kwaye ngokukhawuleza ingqina ukuba kukho ukuphuma kwegazi.

Kwenzeka ntoni kwiSebe eliNgxamisekileyo: Indlela yokunyamekela esibhedlele yosuku olufanayo ikhusela i-80% ye-stroke¶

Ukuqonda iintsika ezine zesibhedlele esingxamisekileyo i-TIA workup ichaza ukuba kutheni ukulinda iintsuku ezimbini kutyelelo lwekliniki yangaphandle kuyingozi kakhulu:

1. Umfanekiso okhawulezayo weBrain kunye neNeck Vessel (CT, CTA, kunye ne-DWI-MRI)¶

• INtloko ye-CT engaMahluko: Ilawula ukopha kakhulu ebuchotsheni okanye ithumba ebuchotsheni ngemizuzu.
• ** I-CT Angiography (CTA) yeNtloko kunye neNtamo (okanye i-Carotid Duplex Ultrasound): ** Imephu yemithambo esuka kwi-aortic arch ukuya entanyeni (**carotid kunye ne-vertebral arteries **) kunye nengqondo (**Circle of Willis **).
• Kutheni le nto ingenakulinda: Ukuba i-CTA okanye i-ultrasound ityhila impawu ezibukhali zangaphakathi ze-carotid artery stenosis (\(70\text{ ukuya }99\text{percent}\) ukucutha, okanye \(50\text{ ukuya }69\text{percent}\) kwizigulane ezikhethiweyo) kwicala elibangele i-TIA, utyando lwe-vascular (utyando lwe-vascular (utyando lotyando luphela)* icwecwe) okanye i-carotid stenting kwisithuba seeyure ezingama-48 ukuya kwiintsuku ezili-14. Ukwenza utyando lwe-carotid kwiintsuku zokuqala emva kwe-TIA kuthintela imivimbo ebulalayo; ukulinda ngaphezu kweeveki ezimbalwa kulahlekelwa uninzi lwenzuzo yokukhusela ngenxa yokuba i-stroke enkulu sele yenzekile.

2. Unyango lwe-Antiplatelet olukhawulezayo oluBini (DAPT): I-CHANCE kunye ne-POINT Trial Protocol¶

Nje ukuba intloko yesebe likaxakeka i-CT ikhuphe ukopha kobuchopho kwaye ukusebenzela akubandakanyi isingqisho sentliziyo esifuna i-anticoagulation epheleleyo: - Kwizigulane ezine-TIA enobungozi obukhulu (amanqaku e-ABCD2 $\ge 4 $)** okanye i-stroke encinci ye-ischemic efika phakathi kwe- ** 24 kwiiyure ze-72 **, oogqirha bexakeka ngokukhawuleza banika ** ukulayisha umthamo wezidakamizwa ezimbini ze-antiplatelet kunye (i-Dual Antiplatelet Therapy, okanye i-DAPT) **: ngokuqhelekileyo ** i-aspirin kunye ne-clopidogrel, i-aspirin esekelwe kwi-land, i-Aspirin esekelwe kwi-Ticagrel *, i-Aspirin, i-Aspirin esekelwe kwi-Land. I-POINT, THALES, kunye ne INSPIRIRES izilingo zeklinikhi) kwifestile emfutshane ye-21 iintsuku, ilandelwa lunyango lwe-agent enye yexesha elide. - Ukuqala i-DAPT kwiiyure zokuqala ze-24 kunciphisa umngcipheko we-stroke enkulu kwiiveki zokuqala ngokuphawulekayo xa kuthelekiswa ne-aspirin yodwa, kunye nenzuzo enkulu eyenzeka kwi- ** yokuqala ye-24 kwiiyure ze-72 **.

3. I-Cardiac Rhythm Monitoring ye-Fibrillation ye-Atrial efihliweyo¶

Ngokumalunga ** i-1 kwi-5 i-ischemic strokes kunye ne-TIAs ** zibangelwa ngamahlwili egazi aqaliswe kwi-appendage ye-atrial ekhohlo yentliziyo ngenxa ** I-Atrial Fibrillation (AFib) **, isigqi sentliziyo esingaqhelekanga esihlala sifika kwaye sihamba ngokuthula (**i-paroxysmal fibrillation ye-atrial **). - Ukuba i-TIA ibangelwa yi-fibrillation ye-atrial, i-aspirin eqhelekileyo ingasebenzi kakuhle; endaweni yoko, isigulane sidinga ** i-anticoagulant yomlomo ** (efana ne-apixaban, i-rivaroxaban, i-dabigatran, i-edoxaban, okanye i-warfarin), eyanciphisa umngcipheko we-stroke malunga ne- ** 65 kwi-70 ipesenti **. - Iqela likaxakeka lenza i-ECG ehamba phambili ye-12, i-telemetry yentliziyo yebhedi eqhubekayo, i-echocardiogram, kwaye ihlala ithumela isigulane ekhaya kunye ne-cardiac patch monitor okanye irekhoda ye-loop implantable.

4. I-High-Intensity Statin Plaque Uzinziso kunye noLawulo loxinzelelo lwegazi¶

Oogqirha bengxamiseko baphinda baqalise i-high-intensity ** i-statin therapy ** (efana ne-atorvastatin okanye i-rosuvastatin) ngokukhawuleza ukuzinzisa iiplagi ze-arterial ezivuthayo kunye nokuzola umgca wesitya, kunye nokulawula ngokucokisekileyo uxinzelelo lwegazi olude.

Inyathelo ngenyathelo lokhathalelo lwangaphambi kwesibhedlele ngelixa ulinde i-ambulensi¶

1. Misa umntu ngokukhuselekileyo kwaye ukwalele ukuqhuba:
2. Cela umntu ahlale kwisitulo esixhasayo okanye angqengqe esofeni okanye ebhedini ephakamise intloko namagxa eengile***.
3. Ungaze uvumele umntu osandul’ ukuba ne-TIA ukuba aziqhubele esibhedlele okanye kukhathalelo olungxamisekileyo. I-TIA yesibini okanye istroke esipheleleyo sisoloko sibetha kwimizuzu eli-15 emva kwesokuqala ngelixa umntu esemva kwevili kuhola wendlela.
4. Yenza kwaye ubhale phantsi isiseko se-6-point BE-FAST check:
5. B (Ibhalansi): Ngaba banokuma okanye bahambe ngokuthe gqolo ngexesha lesiqendu, kwaye ibhalansi yabo injani ngoku?
6. E (Amehlo): Ngaba baye baphulukana nombono kwelinye iliso ("umkhusane wehla") okanye babona kabini? Jonga amehlo omabini ngoku.
7. F (Ubuso): Bacele ukuba bancume kakhulu kwaye baveze amazinyo abo. Ngaba enye ikona yomlomo iye yathotywa ngaphambili? Ngaba i-symmetric ngoku?
8. A (Iingalo & Nemilenze): Bacele ukuba bavale amehlo abo kwaye babambe iingalo zombini ngqo ngaphambili, iintende zijonge phezulu imizuzwana eli-10. Jonga ukuba ingalo enye ihlehlela ezantsi okanye ijikelezise ngaphakathi (pronator drift).
9. I (Intetho): Bacele ukuba baphinde: "Awunakufundisa inja endala amaqhinga amatsha" okanye "Isibhakabhaka siluhlaza eLondon." Qaphela naziphi na iiconsonants ezingacacanga okanye ukuthandabuza ukufumana amagama.
10. T (Ixesha lokungena): Bhala phantsi elona xesha lewotshi liqale ngalo kunye nexesha elichanekileyo lewotshi elisombulule ngalo.
11. Rekhoda ividiyo yemizuzwana engama-30 ukuba uphawu lubuyela umva ngokufutshane:
12. Ukuba umntu ojonge ubuso bakhe, ubudoda besandla, okanye intetho engacacanga iphinda ivele ngokufutshane imizuzwana engama-60 ngelixa ilinde aboncedo lokuqala, ukuba nomntu obukeleyo athathe ividiyo ye-smartphone ye-15-yesibini (ngaphandle kokulibazisa ukhathalelo) inika isibhedlele i-neurologist ubungqina obubonakalayo bendawo eyi-vascular ebandakanyekayo.
13. Jonga i-capillary blood glucose (ukuba ikhona iglucometer):
14. Ukuba umntu uthatha i-insulin okanye iipilisi zesifo seswekile ze-sulfonylurea, hlaba umnwe ukujonga iswekile yegazi. I-Hypoglycemia (\(<3.9\text{mmol/L}\) okanye \(<70\text{ mg/dL}\)) inokubangela ubuthathaka becala elinye kunye nokudideka (hypoglycemic hemiparesis) ephela xa iswekile yegazi ibuyiselwa. Nokuba iswekile yegazi ephantsi ifunyenwe kwaye inyangwe (bona iimeko ezingxamisekileyo zesifo seswekile), basenazo ii-paramedics ezivavanya isigulana.

Iskripthi sonxibelelwano esichanekileyo se-911 / 112 / 999 kunye ne-Emergency Triage¶

Ngenxa yokuba isigulane se-TIA sihlala sibonakala sisempilweni ngokupheleleyo ngexesha abagadi be-paramedics behamba ngomnyango wangaphambili okanye xa benyuka ukuya kwifestile ye-triage yegumbi likaxakeka, ** indlela osichaza ngayo isiganeko sinquma ukuba babonwa ngokukhawuleza okanye iiyure zokulinda kwigumbi lokulinda **. Sebenzisa le script yeklinikhi ichanekileyo:

• Xa ufowunela 911/112/999:

  *"Ndifuna i-ambulensi [Idilesi echanekileyo] yokukrokrela ukuba i-Transient Ischemic Attack okanye i-stroke eguqukayo. [Ngexesha elichanekileyo lokuQala], le [Ubudala] ubudala [indoda/ibhinqa] yaphuhliswa ngequbuliso [i-right/left facial droop / right/left arm weakness / ukungakwazi ukuthetha / ikhethini elimnyama phezu kwe-right/left iliso kunye nesombululo kwi-XE imizuzu]. [Yena] unembali [yoxinzelelo lwegazi oluphezulu / isifo seswekile / i-atrial fibrillation / ukutshaya] ASIzange simgcine [yena] nto ngomlomo kwaye ASIzange simnike i-asprin elinde i-CT scan.

• Xa uthetha noMongikazi weSebe likaxakeka (ukuba sele esibhedlele):

  "Sidinga uvandlakanyo olukhawulezileyo lwe-TIA / i-Acute Stroke Triage. Imizuzu engamashumi amathathu edlulileyo kwi-[Ixesha], [yena] wayenokuqala ngokukhawuleza [chaza ubuthathaka obuchanekileyo becala elinye, ukulahleka kwentetho, okanye ukungaboni ngeliso elinye] ixesha elide [X] imizuzu. Ngokusekelwe kwiminyaka yobudala, uxinzelelo lwegazi, kunye neempawu zemoto / intetho, [i-CD2 yakhe i-6 ngaphakathi] ifestile ebalulekileyo yeeyure ezingama-24 zestroke."

Uluhlu lokukhangela amalungiselelo esibhedlele phambi kokuba i-ambulensi ihambe¶

• Ixesha elichanekileyo lokuqala kunye nexesha lesisombululo esibhalwe ephepheni.
• **Uluhlu olupheleleyo lwamayeza angoku ** (ingakumbi i-blood thinners efana ne-warfarin, i-apixaban, i-rivaroxaban, i-dabigatran, i-clopidogrel, okanye i-aspirin, kubandakanywa nexesha elichanekileyo le-dose yokugqibela iginywe).
• **Inombolo yeselfowuni yengqina lokuzibonela elibone iimpawu ** (ukuba ingqina alikhwelanga kwi-ambulensi, i-neurologist iya kubabiza ngokukhawuleza ukuba iqinisekise ukuba isiqendu sasibukeka njani).
• Amakhadi okufakelwa kwezonyango (i-pacemaker, i-defibrillator, i-valve yentliziyo, okanye i-coronary stents, ngoko isibhedlele sazi ukuba isigulana sinokungena ngqo kwiskena se-MRI).

Imibuzo edla ngokubuzwa¶

Ukuba iimpawu zam ze-stroke zanyamalala ngokupheleleyo kwimizuzu eyi-10, kutheni ndingenako ukucwangcisa idinga kunye nosapho lwam kwiveki ezayo?¶

Uhlaselo lwe-ischemic oludlulayo (i-TIA) luphawu olulumkisayo lokuba i-plaque ye-arterial engazinzanga entanyeni yakho okanye umthombo wehlwili entliziyweni yakho uchitha amahlwili kwingqondo yakho. Phantse isiqingatha sazo zonke izibetho eziphambili, ezikhubaza ngokusisigxina ezilandela i-TIA zenzeke kwii-24 zokuqala kwiiyure ze-48; ukuya kwisebe likaxakeka ngoko nangoko kuvumela oogqirha ukuba bahlole ingqondo nemithambo yentamo yakho, babhaqe i-fibrillation ye-atrial, kwaye baqalise unyango lwe-antiplatelet kabini okanye i-anticoagulant kwangolo suku lunye, olunciphisa umngcipheko wakho we-stroke ukuya kutsho kuma-80 ekhulwini.

Yintoni i-"amaurosis fugax," kwaye kutheni ukulahleka kombono okwethutyana kwelinye iliso kuthathwa njenge-mini-stroke?¶

I-Amaurosis fugax (igama lesiGrike elithetha "ubumnyama obudlulayo") kukuphulukana nombono okungenabuhlungu kwiliso elinye, okuhlala kuchazwa njengekhethini elimnyama okanye umthunzi ohlayo phezu kweliso imizuzu embalwa phambi kokuphakanyiswa. Ngenxa yokuba umthambo wamehlo owondla iretina lisebe lokuqala eliphuma kumthambo wangaphakathi wecarotid osentanyeni, ukuba mnyama okwexeshana kwelinye iliso luphawu oluyisilumkiso oluqatha lomthambo wecarotid ocuthekileyo onokubangela istroke enkulu kwihemisphere kwiiyure okanye iintsuku.

Kutheni izikhokelo zikaxakeka zithi ukulinda i-CT scan esibhedlele ngaphambi kokuba uthathe i-aspirin emva kwe-TIA ekrokrelekayo?¶

Ngelixa i-aspirin kunye ne-clopidogrel ziqalwa ngokukhawuleza esibhedlele xa i-CT scan iqinisekisa ukuba akukho kopha, ukopha kobuchopho obuncinane bomhlaba (okufana ne-cerebral amyloid angiopathy spells kubantu abadala) kunokubangela iziqendu zemizuzu emi-5 ukuya kwe-15 yokusasaza ubundisholo okanye ubuthathaka obuvakala bufana ne-TIA. Ukuthatha i-aspirin ekhaya phambi kokuba intloko yesibhedlele ye-CT ekhawulezayo yemizuzu emi-5 ikhuphe ukopha kunokuguqula ukuvuza okuncinci kwe-cortical ibe kukopha kwengqondo ebulalayo.

Ngaba i-TIA inokushiya umonakalo osisigxina kwi-brain scan naxa umntu evakalelwa ukuba i-100 ekhulwini ibuyele kwisiqhelo?¶

Ewe, izifundo zeklinikhi zisebenzisa i-high-resolution Diffusion-Weighted MRI (DWI) zibonisa ukuba ukuya kuthi ga kwisinye kwisithathu sezigulana ezineempawu ze-stroke zisonjululwe ngokupheleleyo kwimizuzu ukuya kwiyure eneneni zinendawo encinci ye-infarction yezicubu zobuchopho kwi-MRI scan yazo, eqinisekisa ukuba ingqondo isondele kangakanani kwi-stroke eyintlekele kwaye igxininisa ukungxamiseka kokhathalelo lwasesibhedlele olukhawulezileyo.

Imithombo ijongiwe¶

• ** I-American Heart Association (AHA) kunye ne-American Stroke Association (ASA, eUnited States): ** Izikhokelo zokuThintela i-Stroke kwizigulane ezine-Stroke kunye ne-Transient Ischemic Attack * ( I-Stroke *, i-Kleindorfer et al.) kunye * Inkcazo kunye noVavanyo lwe-Transient Ischemic Attack: I-Statement Professional ye-Scientif (i-Easter .
• Iziko leSizwe lezeMpilo kunye nokuGqwesa kweNkathalelo (i-NICE, e-United Kingdom): *I-Stroke kunye ne-Transient Ischemic Attack kwi-Over 16s: Ukuxilongwa kunye noLawulo lokuQala * (I-NICE Guideline NG128, uvavanyo oluphuthumayo lweengcali kunye neeprothokholi zokucinga).
• I-European Stroke Organisation (ESO): Izikhokelo kuLawulo lwe-Transient Ischemic Attack (I-European Stroke Journal, i-Fonseca et al., kubandakanywa ne-double antiplatelet therapy [DAPT] iingcebiso ezivela kwi-CHANCE, POINT, kunye nezilingo ze-THALES).
• IiNgcebiso zokuSebenza eziGqwesileyo zaseKhanada (iNtliziyo kunye neSiseko seStroke saseCanada): UThintelo lweSibini lweStroke kunye neTransient Ischemic Attack Triage kunye neZikhokelo zoLawulo oluNgxamisekileyo.
• UMbutho wezeMpilo weHlabathi (i-WHO) kunye noMbutho weHlabathi weStroke (WSO): Izikhokelo zeGlobal Stroke kunye neSicwangciso sokuSebenza se-Acute Cerebrovascular Triage.

Izikhokelo ezinxulumeneyo¶

• Ukuqaphela i-Stroke (FAST) kunye nokuphendula ngokukhawuleza
• Ukukhubazeka kobuso: ukwahlula ukukhubazeka kukaBell kwi-brainstem stroke
• I-Subarachnoid hemorrhage, intloko ebuhlungu, kunye nokugqabhuka kwe-aneurysm yobuchopho
• Ingxakeko yeHypertension vs. ungxamiseko: xa uxinzelelo lwegazi ludlula i-180/120
• Iimeko ezingxamisekileyo zesifo sikashukela: i-hypoglycemia kunye ne-hyperglycemia yoncedo lokuqala