I-Transient Ischemic Attack (TIA / I-Mini-Stroke) kanye Nokuvimbela I-Stroke Esheshayo¶

Ukuhlasela kwe-ischemic yesikhashana (TIA), okuvame ukubizwa ngokuthi i-mini-stroke noma i-warning stroke, kwenzeka lapho ihlule legazi noma isiqephu soqweqwe sivimba okwesikhashana umthambo ohlinzeka ubuchopho noma iso, okubangela izimpawu zokushaywa unhlangothi kungazelelwe ezibonakala zishabalala ngokuphelele phakathi nemizuzu nehora. Ngenxa yokuthi ihlule liyaphuka noma lizincibilike lodwa ngaphambi kokuba libangele ukufa kwamangqamuzana obuchopho okwandile, abantu abaningi benza iphutha elibulalayo lokubuyela embhedeni noma balinde izinsuku ezimbalwa ukuze bashayele udokotela womndeni wabo. Eqinisweni, i-TIA iyisimo esiphuthumayo sezokwelapha: kufika kumaphesenti angu-10 kuya kwangu-15 abantu abaphethwe i-TIA bazothola unhlangothi olukhulu olukhubaza noma olubulalayo phakathi nezinsuku ezingu-90 ezizayo, futhi cishe ingxenye yaleyo mivimbo eyinhlekelele igadla phakathi namahora okuqala angu-24 kuya kwangu-48. Ukuhlolwa kwesibhedlela ngokushesha ngosuku olufanayo kunciphisa leyo ngozi yokushaywa unhlangothi ngokushesha ngamaphesenti angama-80.

Yenza lokhu manje¶

1. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ngokushesha, ngisho noma zonke izimpawu sezixazululeke ngokuphelele. Dayela u-911 e-United States nase-Canada, 112 ku-European Union yonkana, 999 e-United Kingdom, noma uhlole konke izinombolo eziphuthumayo. Tshela umthumeli ngokucacile ukuthi: "Isiguli sisanda kuba nezimpawu zokushaywa unhlangothi kungazelelwe ezithathe imizuzu engu-[X] futhi singase sibe Nokuhlasela Kwesikhashana Kwe-Ischemic noma i-stroke eshintshayo." Cela ukuthutha ku-Stroke Center eqinisekisiwe.
2. Bhala phansi umzuzu oqondile izimpawu eziqale ngazo ("Isikhathi Sokugcina Ukwaziwa Kahle") kanye nomzuzu oqondile eziyeke ngawo. Odokotela bezimo eziphuthumayo bathembele ewashini eliqondile lokuqala kanye nobude besikhathi ukuze babale ingozi yesiguli yamahora angu-24 yokushaywa unhlangothi kanye nokuthola ukufaneleka kokwelashwa okuqhunyiswa ngomthambo ihlule (thrombolysis) uma izimpawu zibuya ngokuzumayo lapho i-ambulensi isesimweni esiphuthumayo.
3. UNGANIKEZI i-aspirin, i-clopidogrel, i-ibuprofen, nanoma iyiphi into enciphisa igazi kuze kube yilapho i-CT scan yasesibhedlela ikhipha ukopha kobuchopho. Nakuba ukwelapha okumbaxambili kwe-antiplatelet (i-aspirin kanye ne-clopidogrel noma i-ticagrelor) kuqalwa emnyangweni wezimo eziphuthumayo ngokushesha ngemuva kwe-neuroimaging, ukuphuza i-aspirin ekhaya ngaphambi kwe-CT scan yekhanda kuyingozi ngenxa yokuthi i-transket ye-hemorrhagic ingaba nezimpawu ezimfushane ze-neurological.
4. Ugcine umuntu engenalutho ngomlomo (NPO) futhi uhlezi noma ulele ngokunethezeka ikhanda lakhe lisezingeni elingu-30 degrees. Ungamniki ukudla, amanzi, noma amaphilisi omlomo, njengoba i-ischemia ye-brain stem ngokuvamile ilimaza i-gag kanye nokugwinya okukhaliphile ngaphandle kwezimpawu ezisobala zangaphandle, okudala ingozi enkulu yokuklinywa noma i-aspiration pneumonia.
5. Phinda uhlole imizwa ye-BE-FAST njalo emizuzwini emi-5 kuya kweyi-10 ngenkathi ulinde abezimo eziphuthumayo. Bukela eduzecrescendo TIAs (ebuye ibizwe ngokuthi i-capsular warning syndrome), lapho izimpawu zifika ziphinde zidlule isikhathi esingaphezu kwehora ngaphambi kokuba zikhiyeleke ekukhubazekeni unomphela. Uma izimpawu zibuya, xwayisa abezimo eziphuthumayo i-TIA eseyiguqule yaba esebenzayo unhlangothi.
6. Hlola ushukela wegazi uma umuntu enesifo sikashukela, bese ukala isigqi sokushaya kwenhliziyo nomfutho wegazi uma okokusebenza kuseduze. Ukwehla kakhulu kukashukela egazini (eziphuthumayo zesifo sikashukela neglucose engaphansi kuka-\(3.9\text{ mmol/L}\) noma \(70\text{ mg/dL}\)) ingalingisa i-TIA ngokufanayo. Uma une-pulse oximeter noma i-blood pressure cuff, qaphela ukuthi ukushaya kwenhliziyo akujwayelekile yini (inkomba yokuthi i-atrial fibrillation) bese ubhala phansi umfutho wegazi ngaphandle kokuzama ukuwehlisa ekhaya.

Ukuhlolwa kwesimo esiphuthumayo kanye nesihlahla sesinqumo sokuhlola i-TIA¶

Sebenzisa leli shidi lokugeleza lomtholampilo ukuze uphendule lapho othile eba nezimpawu zemizwa noma ezibonakalayo kungazelelwe, kungakhathaliseki ukuthi lezo zimpawu zisekhona noma seziphele nya.

flowchart TD
    Start["Isiqephu Sezinzwa Ngokungazelelwe:<br/>Ukulahlekelwa ibhalansi, Ubumpumputhe bamehlo/ukubona kabili,<br/>Ubuso obugencekile, ukuba buthakathaka kwengalo/umlenze noma ukuba ndikindiki,<br/>Ukukhuluma kahle noma ukudideka kwegama"] --> ActiveCheck{"INGABE YIZIPHI izimpawu<br/>ezisekhona njengamanje?"}

    ActiveCheck -->|"YEBO: Ngisho nokushuba okuncane noma ukumisa kancane ukuthola amagama"| ActiveStroke["IKHODI YE-Stroke Esebenzayo (Bheka Umhlahlandlela We-Stroke):<br/>1. Shayela ku-911 / 112 / 999 Ngokushesha<br/>2. Rekhoda sona kanye isikhathi 'sokugcina Ukwaziwa'<br/>3. Gcina i-NPO; UNGAMniki i-aspirin ngaphambi kwe-CT scan<br/>4. Shesha ku-Thrombectomy / Thrombolysis Center"]

    ActiveCheck -->|"CHA: Izimpawu zixazululwe ngo-100% emuva kwesisekelo"| SuspectTIA["OKUSOLWA UKUHLASELWA KWE-ISCHEMIC OKUPHAKATHI (TIA)<br/>(Iwindi Eliphakeme Le-Stroke Yamahora angu-24 kuya kwangu-48)"]

    SuspectTIA --> CallEMS["Shayela ku-911 / 112 / 999 Ngokushesha:<br/>Ungalindi isikhathi sokubonana emtholampilo kusasa.<br/>Ungasivumeli isiguli sizishayele."]

    CallEMS --> HomeSafety["Izinyathelo Zokuvikela Ngaphambi Kwesibhedlela:<br/>1. UNGANIKEZI i-Aspirin kuze kube yilapho i-CT yobuchopho ikhipha umthetho wokuthi akukho ukopha<br/>2. Gcina i-NPO (akukho ukudla, isiphuzo, noma amaphilisi omlomo)<br/>3. Ngena esinembile isikhathi sokuqala, ubude besikhathi, nokushoda okuthile<br/>4. Phinda uhlole i-BE-FAST njalo emizuzwini engu-5-10 ukuze uqalise kabusha"]

    HomeSafety --> RiskCheck{"Hlola I-ABCD2 Yengozi Ephezulu & Nezimpawu Ezibomvu Ze-Vascular:<br/>- Ukuphazamiseka kwenkulumo noma ubuthakathaka obuhlangothini olulodwa?<br/>- Isiqephu sithathe >= amaminithi angu-10?<br/>- Iziqephu eziningi zokubuyela emuva ('Crescendo TIA')?<br/>- I-fibrillation ye-atrial eyaziwayo, i-caroti> 6 i-carotid= ubuhlungu obudala > i-carotid = ubuhlungu obungajwayelekile ikhethini phezu kweso elilodwa (Amaurosis Fugax)?"}

    RiskCheck -->|"Noma yikuphi Okukhona Noma Okungaqiniseki"| HospitalWorkup["Ukusebenza Kwesibhedlela Ngehora elifanayo:<br/>1. Ikhanda elingahlukanisi I-CT + CT Angiogram (Ikhanda Nentamo)<br/>2. I-Diffusion-Weighted Brain MRI (DWI)<br/>3. 12-Lead ECG & Telemetry for Atrial Fibrillation<br/>4. I-Immediate Dual Antiplatelet Therapy (DAPT) uma ukopha kwakhishwa ngaphandle"]

Kwenzekani ngaphakathi kobuchopho ngesikhathi se-TIA (nokuthi kungani incazelo endala yamahora angama-24 ishintshile)¶

Emashumini eminyaka, izincwadi zezokwelapha zisebenzisa incazelo ethi yesikhathi esisekelwe ye-TIA: noma yikuphi okushodayo okugxilile okuzumayo kwemizwa okuhlala ngaphansi kwamahora angu-24. I-neuroimaging yesimanje ene- Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) ifakazele ukuthi le ncazelo yakudala yayidukisa ngokuyingozi. Ucwaningo olwenziwa yi-American Heart Association (AHA) kanye ne-American Stroke Association (ASA) lubonise ukuthi **30 kuya kumaphesenti angu-50 eziguli ezinezimpawu zokushaywa unhlangothi ezixazululeka phakathi kwehora elingu-1 kuya kwangu-24 empeleni zinezindawo ezihlala njalo, ezincane zezicubu zobuchopho ezifile ku-MRI scan **.

Namuhla, i-AHA/ASA, European Stroke Organization (ESO), kanye ne-World Health Organization zisebenzisa incazelo yesimanje esekelwe ezicutshini: - I-Transient Ischemic Attack (TIA): Isiqephu sesikhashana sokungasebenzi kahle kwezinzwa okubangelwa ubuchopho obugxilile, intambo yomgogodla, noma i-ischemia ye-retinal, ngaphandle kwe-acute infarction (ukufa kwezicubu unomphela) ekucabangeni kobuchopho. Ama-TIA amaningi eqiniso ahlala kuphela imizuzu emi-2 kuya kweyi-15; uma ukushoda kuthatha isikhathi eside kunemizuzu engama-60, amaphesenti angaphansi kwe-15 axazulula phakathi namahora angama-24 ngaphandle kokushiya isibazi esihlala njalo ku-MRI. - Kungani i-TIA yenzeka: Ihlule noma ikristalu ye-cholesterol iyaxebuka emthanjeni wentamo ewumngcingo (internal carotid noma vertebral artery stenosis) noma inhliziyo (atrial fibrillation noma i-valve yenhliziyo), noma umthambo omncane ojulile ongenela ebuchosheni obunyakazayo namapulaki (**miacuna). Emaminithini ambalwa, ama-neurons aphansi komfula alahlekelwa ukugeleza kwegazi ngaphansi komkhawulo wokwehluleka kukagesi (\(<20\text{ mL/100g/min}\)) futhi ayeke ukudubula, okubangela ukukhubazeka, ukuba ndikindiki, noma ukungaboni. Ngaphambi kokuthi izicubu zeqe umkhawulo ongenakulungiseka weseli-death (\(<10\text{ mL/100g/min}\)), ama-enzyme egazi emvelo ancibilikisa ihlule noma imithambo ehlangene evulekayo, ibuyisela ukusebenza. - Kungani amahora angu-24 kuya kwangu-48 abalulekile: I-plaque enezilonda engazinzile emthanjeni wasentanyeni noma igumbi elenza amahlule enhliziyweni eliqhume "isibhamu esiyisixwayiso" sokuqala lisachitha amahlule. Ngaphandle kokuzinza ngokushesha kwezokwelapha, ihlule elilandelayo elethulwa emahoreni ambalwa kamuva livame ukuba likhulu futhi libangele unhlangothi olungapheli, olubhubhisayo.

Ukubona izimpawu ze-TIA zakudala neze-atypical¶

Ngenxa yokuthi ubuchopho bulawula imisebenzi ehlukene ezindaweni ezintathu ezinkulu zemithambo, i-TIA ayihlali ibukeki njengesithombe sakudala sikamabonakude sobuso obudangele nengalo ekhubazekile. Sebenzisa ukuhlola okuthi BE-FAST okunwetshiwe futhi ubone amaphethini amathathu athile e-anatomical:

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

• I-Amaurosis Fugax ("I-Fleeting Blindness" Esweni Elilodwa): I-ophthalmic artery igatsha lokuqala le-carotid artery ngaphakathi kogebhezi. Lapho i-cholesterol crystal (Hollenhorst plaque) noma ihlule le-platelet liphuma emithanjeni ye-carotid engumngcingo entanyeni, ngokuvamile lidubula liqonde emthanjeni we-retinal iso elilodwa. Iziguli zichaza ngokuzumayo, okungenabuhlungu ngokuphelele "umthunzi omnyama, ikhethini elimpunga, noma impumputhe yase-Venetian edonsela phansi noma ewela iso elilodwa" ethatha imizuzu engu-1 ukuya kweyi-10 bese iphindela phezulu.
• Ubuthakathaka obuphikisanayo noma ukuba ndikindiki: Ubuthakathaka obungalindelekile, ukuba nzima, ukugabadela, noma ukuba ndikindiki okufile kobuso, ingalo, kanye/noma umlenze ohlangothini oluphambene lomzimba (isibonelo, umthambo we-carotid wesokunxele i-TIA ibangela ukushona kobuso ohlangothini lwesokudla kanye nobuthakathaka besandla sokudla).
• I-Aphasia noma i-Dysarthria (Ukulahlekelwa Kolimi & Nenkulumo): Uma i-hemisphere ebusayo (cishe ngaso sonke isikhathi iyingxenye yesobunxele yobuchopho) ithinteka, umuntu angase angakwazi ukukhuluma ngokuzumayo, ashintshe amagama angalungile (**isaladi yamagama **), noma angakwazi ukuqonda amagama akhulunywayo noma abhaliwe (i-aphasia eyamukelayo), ngisho nangemizuzu engu-3 nje kuphela.

2. I-Posterior Circulation TIA (I-Vertebrobasilar Territory, Evamise Ukuphuthelwa Ekunqumeni)¶

Imithambo emibili yomgogodla kanye ne-basilar artery inikeza i-brainstem, i-cerebellum, ne-occipital visual lobes. Ama-TIA angemuva ajwayele ukuhlonzwa ngokungeyikho njenge-vertigo yendlebe yangaphakathi noma ukukhathala: - I-Hemianopia Engaziwa: Ukulahlekelwa okungazelelwe kwengxenye yesokunxele noma ingxenye yesokudla yenkambu yokubuka kuwo womabili amehlo kanye kanye. - I-"5 Ds" ye-Brainstem Ischemia: Ngokungazelelwe Isiyezi/Vertigo (umuzwa wokuphotha ohambisana nezinye izimpawu zemizwa), Diplopia (ukubona okuphindwe kabili ngokuzumayo lapho womabili amehlo evulekile), I-Dysarthria (inkulumo engaqondakali), Dysphagia (ubunzima bokugwinya* ngokuzumayo* ukugwinya* okuzumayo), kanye (Ubunzima bokugwinya ngokuzumayo), kanye (*Ubunzima bokugwinya) umunwe emakhaleni ngokunembile). - Ukusilela Kwezinzwa Ezidlulele: Ukuba ndikindiki ohlangothini olulodwa lobuso kubhangqwe nokuba ndikindiki noma ubuthakathaka ngakolunye uhlangothi lomzimba.

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

Ku- capsular warning syndrome, ukuvaleka kwesikhashana komthambo omncane owodwa ongena (ngokuvamile igatsha le-lenticulostriate eliphakela i-capsule yangaphakathi, lapho yonke imicu yezinzwa ye-motor inqwabelanisa ndawonye) kubangela 3 kuya kwezingu-10+ iziqephu ezibuyela emuva zokukhubazeka okuphelele kohlangothi olulodwa lobuso, ingalo, nomlenze phakathi namahora angu-12 kuya kwangu-24. Phakathi kweziqephu, umuntu ubukeka ejwayele ngokuphelele imizuzu engu-20, bese elahlekelwa ngokuzumayo konke ukunyakaza ohlangothini olulodwa futhi. **Kufika kumaphesenti angu-40 eziguli ezine-capsular warning syndrome ziqhubekela ekushayweni okungapheli, okukhubaza phakathi nezinsuku **, okwenza kube isibopho sokungeniswa ngokushesha kwe-ICU/Stroke Unit.

Ukuqhathanisa okuphelele: I-TIA iqhudelana ne-Completed Stroke vs. I-Common TIA Mimics¶

Odokotela bezimo eziphuthumayo bahlola izimo ezimbalwa ezimbi neziyingozi ("TIA silingisa") ezingalingisa okwesikhashana i-mini-stroke. Qhathanisa izici ezingezansi:

Ukubala ubungozi bokushaywa unhlangothi ngokushesha: I-ABCD2 Clinical Score¶

Iminyango yezimo eziphuthumayo emhlabeni wonke isebenzisa i-ABCD2 Score eqinisekisiwe ehambisana ne-vascular imaging ukuze icacise ukuthi isiguli se-TIA singaba nesifo sohlangothi esigcwele kangakanani phakathi kwamahora ama-48 alandelayo. Ukuqonda lezi zici ezinhlanu kubonisa ukuthi kungani abezimo eziphuthumayo nezibhedlela bephatha ama-TIA athile njengezimo eziphuthumayo zama-alamu amahlanu:

Kusho ukuthini Ingqikithi Ye-ABCD2 Score (0 kuya ku-7 Amaphuzu):¶

• Amaphuzu angu-0 kuye ku-3 (Amaphuzu Aphansi, kodwa AKALOKHO Ingozi Izero): cishe u-\(1.0\text{ percent}\) engcupheni yokushaywa unhlangothi enkulu phakathi namahora angu-48. Isexwayiso esibalulekile esivela ku-NICE (UK) kanye ne-AHA/ASA: Ngisho nesiguli esinesikolo se-ABCD2 sika-\(0\text{ noma }1\) singaba ne-carotid artery evinjiwe engu-90% (isibonelo, umuntu oneminyaka engu-55 ubudala ongenaso isifo sikashukela onesiqephu esiyimizuzu engu-3 sobumpumputhe beso elilodwa esidinga amaphoyinti e-x CD0 $ nokho ku-amaurosis ye-CD0 edinga amaphoyinti e-CD adinga i-$ ukuhlinzwa okuphuthumayo kwe-carotid). Ngakho-ke, imihlahlandlela yesimanje incoma i-neuroimaging ephuthumayo yosuku olufanayo ne-vascular imaging YAWO WONKE ama-TIA asolwayo, ngokunganaki isikolo se-ABCD2.
• Amaphuzu 4 kuya ku-5 (Ingozi Emaphakathi-Ephezulu): \(4.1\text{ percent}\) ingozi yokushaywa unhlangothi phakathi namahora angu-48; okuhloswe ngakho ukungeniswa esibhedlela ngokushesha kanye nokwelashwa okukabili kwe-antiplatelet (DAPT).
• Isikolo 6 ukuya ku-7 (Ingozi Edlulele): \(8.1+\text{ percent}\) ingozi yokukhubaza unhlangothi phakathi namahora angu-48 (futhi iphakeme nakakhulu uma i-carotid stenosis noma i-atrial fibrillation ikhona).

Kungani UNGAMALI unike i-aspirin ekhaya ngaphambi kwe-CT scan yobuchopho: I-"Amyloid Spell" Trap¶

Umbuzo ovamile ovela emindenini uthi: "Uma i-TIA ibangelwa ihlule elincane, akufanele yini sinikeze ithebhulethi ye-aspirin engu-300 mg ngokushesha ekhaya?" Imihlahlandlela yesimanje ye-neurology (kuhlanganise ne-UK National Institute for Health and Care Excellence [NICE NG128] ihlanganisa kanye AHA/ASA ASA Acute Stroke Guidelines) kuze kube yilapho i-CT inikezwa i-Acute Stroke Guidelines kuze kube yilapho kwenziwa i-CT ephuthumayo Izinkombandlela ze-Stroke imaging) umnyango ngaphambi kokunikeza i-aspirin** noma nini lapho ezokuthutha eziphuthumayo zitholakala, ngenxa yezizathu ezimbili ezisindisa ukuphila:

1. Iziqephu ze-Transient Focal Neurological ("Izipeli ze-Amyloid"): Kubantu abadala abaneminyaka engaphezu kuka-60, isimo esibizwa ngokuthi Cerebral Amyloid Angiopathy (CAA) senza imithambo yegazi emincane engaphandle kobuchopho ibe buthaka. Uma omunye wale mithambo ongaphezulu uvuza ithonsi elincane legazi emithonjeni yobuchopho (convexity subarachnoid hemorrhage noma i-cortical superficial siderosis), ithukuthelisa inzwa noma i-motor cortex, ibangele isiqephu esiyimizuzu emi-5 kuya kweyi-15 sokusabalalisa ubundikindiki, ukubukeka kobuso* kanye nobuthakathaka obuthile. Ukunikeza i-aspirin noma i-clopidogrel esigulini esine-"amyloid spell" kungase kubangele ukopha okukhulu, okubulalayo kobuchopho be-lobar phakathi namahora.
2. I-Evolving Hemorrhagic Stroke: Ukopha okuncane okujulile kwe-intracerebral ngezikhathi ezithile kungase kuqale ngokuba namalimi noma izimpawu ezithambile ngaphambi kokukhula. I-CT scan yekhanda elingahlukanisi ekamelweni lezimo eziphuthumayo ithatha imizuzu engaphansi kwemi-5 futhi ifakazela ngokushesha ukuthi ukopha kukhona yini.

Kwenzekani Emnyangweni Wezimo Eziphuthumayo: Ukunakekelwa kwesibhedlela kosuku olufanayo kuvimbela kanjani u-80% wokushaywa unhlangothi¶

Ukuqonda izinsika ezine zesibhedlela esiphuthumayo sokusebenza kwe-TIA kuchaza ukuthi kungani ukulinda izinsuku ezimbili ukuze uvakashele emtholampilo wangaphandle kuyingozi kakhulu:

1. I-Imaging Esheshayo Yengqondo Nentamo (CT, CTA, ne-DWI-MRI)¶

• I-CT Yekhanda Engahlukile: Ikhipha ukopha okukhulu ebuchosheni noma isimila sobuchopho ngamaminithi.
• I-CT Angiography (CTA) Yekhanda Nentamo (noma i-Carotid Duplex Ultrasound): Imephu imithambo esuka ku-aorta arch iye phezulu entanyeni (carotid kanye ne-vertebral arteries) nasebuchosheni (Circle of Willis).
• Kungani lokhu kungeke kulinde: Uma i-CTA noma i-ultrasound yembula isifo sokuqina kwemithambo ye-carotid yangaphakathi eqinile (\(70\text{ kuya }99\text{percent}\) incipha, noma \(50\text{kuya }kuya }69\text{ percent}\) ezigulini ezikhethiwe) ohlangothini olubangele i-TIA, odokotela abahlinza imithambo* benza ukuhlinzwa** i-plaque) noma i-carotid stenting phakathi kwamahora angu-48 kuya ezinsukwini ezingu-14. Ukwenza ukuhlinzwa kwe-carotid ezinsukwini zokuqala ngemuva kwe-TIA kuvimbela imivimbo ebulalayo; ukulinda isikhathi esingaphezu kwamasonto ambalwa kulahlekelwa iningi lenzuzo yokuzivikela ngenxa yokuthi i-stroke enkulu isivele yenzekile.

2. I-Immediate Dual Antiplatelet Therapy (DAPT): Iphrothokholi ye-CHANCE ne-POINT Trial¶

Uma inhloko yomnyango wezimo eziphuthumayo i-CT ikhipha ukopha kobuchopho futhi ukuqeqeshwa akufaki ihlule lesigqi senhliziyo esidinga i-anticoagulation ephelele: - Ezigulini ezine-TIA esengozini enkulu (amaphuzu we-ABCD2 \(\ge 4\))** noma isifo sohlangothi esincane se-ischemic esifika phakathi kwamahora angu-24 kuya kwangu-72, odokotela bezimo eziphuthumayo ngokushesha banikeza umthamo wokulayisha wezidakamizwa ezimbili ze-antiplatelet ndawonye (i-Dual Antiplatelet Therapy, noma i-DAPT): ngokuvamile aspirin plus clopidogrel, aspirini-clopidogrel, aspirini esekelwe ANCE ticagre* I-POINT, THALES, kanye nokuhlolwa komtholampilo OKUKHUTHAZA) iwindi elifushane elithi izinsuku ezingu-21, okulandelwa ukwelashwa komenzeli oyedwa isikhathi eside. - Ukuqala i-DAPT phakathi kwamahora angu-24 okuqala kunciphisa ingozi yokushaywa unhlangothi okukhulu emasontweni okuqala ngokuphawulekayo uma kuqhathaniswa ne-aspirin iyodwa, ngenzuzo enkulu kakhulu eyenzeka kumahora okuqala angu-24 kuya kwangu-72.

3. Ukuqapha Isigqi Senhliziyo Ye-Atrial Fibrillation Efihliwe¶

Cishe 1 kokungu-5 ukushaywa kwe-ischemic kanye nama-TIA kubangelwa amahlule egazi aqaliswe e-atrial yesokunxele yenhliziyo ngenxa I-Atrial Fibrillation (AFib), isigqi senhliziyo esingavamile esivame ukuza futhi sihambe buthule (paroxysmal atrial fibrillation). - Uma i-TIA ibangelwa i-atrial fibrillation, i-aspirin evamile ayisebenzi ngokuqhathaniswa; esikhundleni salokho, isiguli sidinga i-anticoagulant yomlomo (efana ne-apixaban, i-rivaroxaban, i-dabigatran, i-edoxaban, noma i-warfarin), enciphisa ingozi yokushaywa unhlangothi cishe 65 kumaphesenti angu-70. - Ithimba lezimo eziphuthumayo lenza i-ECG ehamba phambili engu-12, i-telemetry yenhliziyo eseceleni kombhede eqhubekayo, i-echocardiogram, futhi ngokuvamile ithumela isiguli ekhaya ngesiqaphi senhliziyo esigqokekayo noma isiqophi se-loop esifakelwayo.

4. I-High-Intensity Statin Plaque Ukuzinza kanye Nokulawula Umfutho Wegazi¶

Odokotela bezimo eziphuthumayo baphinde baqale umfutho ophezulu ukwelashwa kwe-statin (okufana ne-atorvastatin noma i-rosuvastatin) ngokushesha ukuze kuzinze ama-arterial plaques avuvukele kanye nokuthulisa ulwelwesi lwemikhumbi, kanye nokulawula ngokucophelela umfutho wegazi wesikhathi eside.

Isinyathelo ngesinyathelo ukunakekelwa kwangaphambi kwesibhedlela ngenkathi ulinde i-ambulensi¶

1. Misa umuntu ngokuphepha futhi uvimbele ukushayela:
2. Cela umuntu ahlale esihlalweni esimsekelayo noma alale esofeni noma embhedeni ephakamise ikhanda namahlombe ku-30-degree angle.
3. Ungalokothi uvumele umuntu osanda kuba ne-TIA ukuthi azishayele azishayelele esibhedlela noma ekunakekelweni okuphuthumayo. I-TIA yesibili noma unhlangothi olugcwele luvamise ukushaya emizuzwini engu-15 ngemva kokokuqala ngesikhathi umuntu eshayela kuthelawayeka.
4. Yenza futhi ubhale phansi isheke lesisekelo samaphuzu angu-6 BE-FAST:
5. B (Ibhalansi): Bangakwazi yini ukuma noma bahambe kancane phakathi nesiqephu, futhi ibhalansi yabo injani njengamanje?
6. E (Amehlo): Ingabe balahlekelwa ukubona esweni elilodwa ("ikhethini lehla") noma babona kabili? Bheka amehlo womabili manje.
7. F (Ubuso): Bacele bamamatheke kakhulu futhi baveze amazinyo abo. Ingabe ikona elilodwa lomlomo lake lagoba ngaphambili? Ingabe i-symmetric manje?
8. A (Izingalo Nemilenze): Bacele ukuthi bavale amehlo abo futhi babambe izingalo zombili ziqonde ngaphambili izintende zibheke phezulu imizuzwana eyi-10. Buka ukuthi ingabe ingalo eyodwa ikhukhulela phansi noma ijikela ngaphakathi (pronator drift).
9. I (Inkulumo): Bacele ukuthi baphinde: "Awukwazi ukufundisa inja endala amaqhinga amasha" noma "Isibhakabhaka siluhlaza e-London." Qaphela noma yimaphi ongwaqa abaluvalile noma ukungabaza kokuthola amagama.
10. T (Irekhodi Lesikhathi): Bhala phansi isikhathi esiqondile sewashi isiqephu esiqale ngaso kanye nesikhathi esiqondile sewashi esixazulule ngaso.
11. Rekhoda ividiyo yamasekhondi angama-30 uma uphawu lubuyela emuva kafushane:
12. Uma ubuso bomuntu buqulekile, ukuxega kwesandla, noma inkulumo engacacile ivela futhi kafushane imizuzwana engu-60 ngesikhathi ilinde abezimo eziphuthumayo, ukuba nomuntu obukele athwebule ividiyo ye-smartphone yamasekhondi angu-15 (ngaphandle kokulibazisa ukunakekelwa) kunikeza udokotela wezinzwa zesibhedlela ubufakazi obubonakalayo obungenakuphikwa bendawo yemithambo yegazi ehilelekile.
13. Hlola i-capillary blood glucose (uma ikhona iglucometer):*
14. Uma umuntu ephuza amaphilisi e-insulin noma e-sulfonylurea, hlaba umunwe ukuze uhlole ushukela osegazini. I-Hypoglycemia (\(<3.9\text{ mmol/L}\) noma \(<70\text{ mg/dL}\)) ingabangela ubuthakathaka obungalindelekile ohlangothini olulodwa nokudideka (hypoglycemic hemiparesis) enyamalalayo lapho ushukela osegazini ubuyiselwa. Noma ngabe ushukela wegazi ophansi utholakala futhi welashwa (bona eziphuthumayo zesifo sikashukela), kusenabo abezimo eziphuthumayo abahlola isiguli.

Umbhalo oqondile wokuxhumana we-911 / 112 / 999 kanye ne-Emergency Triage¶

Ngenxa yokuthi isiguli se-TIA sivame ukubukeka siphile saka ngesikhathi abezimo eziphuthumayo behamba ngomnyango ongaphambili noma lapho bekhuphukela efasiteleni legumbi lezimo eziphuthumayo, indlela osichaza ngayo isenzakalo inquma ukuthi babonakala ngokushesha noma amahora okulinda endlini yokulinda. Sebenzisa lesi script somtholampilo esiqondile:

• Uma ushayela ku-911/112/999:

  *"Ngidinga i-ambulensi kokuthi [Ikheli Eliqondile] ngezinsolo Zokuhlasela Kwe-Ischemic Esikhashana noma ukushaywa unhlangothi. [Isikhathi Esiqondile Sokuqala], le [Iminyaka] ubudala [indoda/yesifazane] ikhule ngokuzumayo [iconsi yobuso kwesokudla/kwesokunxele / kwesokudla/kwesokunxele ingalo ubuthakathaka / ukungakwazi ukukhuluma / ikhethini elimnyama phezu kweso kwesokudla/kwesokunxele kanye nesokunxele ngesikhathi X]. [Yena] unomlando [womfutho wegazi ophakeme / isifo sikashukela / i-atrial fibrillation / ukubhema] Asimgcinanga lutho ngomlomo futhi ASIzange simnike i-aspirin kusalindwe ukuhlolwa kwe-CT scan.

• Lapho ukhuluma Nomhlengikazi Wokuhlolwa Kwezimo Eziphuthumayo (uma esevele usesibhedlela):

  "Sidinga ukuhlolwa okusheshayo kwe-TIA / Acute Stroke Triage. Emizuzwini engamashumi amathathu edlule [Ngesikhathi], [yena] ube nokuvela okuzumayo [chaza ngokuqondile ubuthakathaka obuhlangothi olulodwa, ukulahlekelwa inkulumo, noma ubumpumputhe beso elilodwa] okuhlala isikhathi eside [X] amaminithi. Ngokusekelwe eminyakeni yobudala, umfutho wegazi, kanye nezimpawu zemoto/inkulumo, [i-CD4/i-score yethu ingaphakathi] iwindi elibucayi lamahora angama-24."

Uhlu lokuhlola ukulungiswa kwesibhedlela ngaphambi kokuba i-ambulensi ihambe¶

• Isikhathi esiqondile sokuqala nesikhathi sokuxazulula esibhalwe ephepheni.
• Uhlu oluphelele lwemithi yamanje (ikakhulukazi okokunciphisa igazi njenge-warfarin, i-apixaban, i-rivaroxaban, i-dabigatran, i-clopidogrel, noma i-aspirin, okuhlanganisa nesikhathi esiqondile lapho umthamo wokugcina ugwinywe khona).
• Inombolo kamakhalekhukhwini kafakazi wokuzibonela owabona izimpawu (uma ufakazi engagibeli i-ambulensi, udokotela wezinzwa uzobashayela ucingo ngokushesha ukuze aqinisekise ukuthi isiqephu sasibukeka kanjani).
• Amakhadi okufakelwa kwezokwelapha (i-pacemaker, i-defibrillator, i-valve yenhliziyo, noma ama-coronary stents, ukuze isibhedlela sazi ukuthi isiguli singangena ngokuqondile kusithwebuli se-MRI).

Imibuzo evame ukubuzwa¶

Uma izimpawu zami zohlangothi zinyamalala ngokuphelele emizuzwini eyi-10, kungani ngingakwazi ukuhlela isikhathi sokubonana nodokotela womndeni wami ngesonto elizayo?¶

Ukuhlasela kwe-ischemic yesikhashana (i-TIA) kuwuphawu oluyisixwayiso lokuthi i-plaque ye-arterial engazinzile entanyeni yakho noma umthombo wehlule enhliziyweni yakho ichitha amahlule ebuchosheni bakho. Cishe isigamu sayo yonke imivimbo emikhulu, ekhubaza unomphela elandela i-TIA kwenzeka phakathi namahora angu-24 kuya kwangu-48 okuqala; ukuya emnyangweni wezimo eziphuthumayo ngokushesha kuvumela odokotela ukuba baskene imithambo yobuchopho nentamo yakho, bathole i-fibrillation ye-atrial, futhi baqale ukwelashwa okumbaxambili kwe-antiplatelet noma i-anticoagulant ngosuku olufanayo, okunciphisa ingozi yakho yokushaywa unhlangothi ngamaphesenti angaba ngu-80.

Iyini i-"amaurosis fugax," futhi kungani ukulahlekelwa umbono wesikhashana kwelinye iso kuthathwa njenge-mini-stroke?¶

I-Amaurosis fugax (isiGreki esisho "ubumnyama obudlulayo") ukulahlekelwa okungenabuhlungu kokubona esweni elilodwa, ngokuvamile okuchazwa njengekhethini elimnyama noma umthunzi odonsela phansi phezu kweso imizuzu embalwa ngaphambi kokuphakamisa. Ngenxa yokuthi umthambo wamehlo ophakela i-retina uyigatsha lokuqala eliphuma kumthambo we-carotid wangaphakathi osentanyeni, ubumnyama besikhashana esweni elilodwa kuwuphawu oluyisixwayiso oluvamile lokuncipha okukhulu komthambo we-carotid ongabangela ukushaywa okukhulu kwe-hemisphere phakathi namahora noma izinsuku.

Kungani imihlahlandlela yezimo eziphuthumayo ithi ukulinda i-CT scan yasesibhedlela ngaphambi kokuthatha i-aspirin ngemva kwe-TIA esolwayo?¶

Ngenkathi i-aspirin ne-clopidogrel ziqalwa ngokushesha esibhedlela uma i-CT scan iqinisekisa ukuthi akukho ukopha, ukopha okuncane kobuchopho obungaphezulu (okufana nokupela kwe-cerebral amyloid angiopathy kubantu abadala) kungabangela iziqephu zemizuzu emi-5 kuya kweyi-15 zokusabalalisa ubundikindiki noma ubuthakathaka obuzwakala bufana ne-TIA. Ukuthatha i-aspirin ekhaya ngaphambi kwekhanda lesibhedlela le-CT scan elisheshayo lemizuzu emi-5 likhiphe umthetho wokuthi ukopha kungashintsha ukuvuza okuncane kwe-cortical kube ukopha okubulalayo ebuchosheni.

Ingabe i-TIA ingashiya umonakalo unomphela ekuhlolweni kobuchopho ngisho nalapho umuntu ezwa amaphesenti angu-100 ebuyela kokujwayelekile?¶

Yebo, ucwaningo lwemitholampilo olusebenzisa i-Diffusion-Weighted MRI (DWI) enesinqumo esiphezulu lubonisa ukuthi kufika ingxenye eyodwa kwezintathu yeziguli ezinezimpawu zokushaywa unhlangothi zixazululeka ngokuphelele phakathi nemizuzu kuya ehoreni empeleni zinendawo encane ye-infarction yezicubu zobuchopho unomphela ekuhlolweni kwazo kwe-MRI, okuqinisekisa ukuthi ubuchopho busondele kangakanani ekushayweni okuyinhlekelele futhi kugcizelela ukuphuthuma kokunakekelwa esibhedlela ngokushesha.

Imithombo ihloliwe¶

• I-American Heart Association (AHA) kanye ne-American Stroke Association (ASA, United States): Imihlahlandlela Yokuvimbela I-Stroke Ezigulini Ezinesifo Sohlangothi Nokuhlasela Kwe-Ischemic Esikhashana (Stroke, Kleindorfer et al.) kanye Nencazelo Nokuhlolwa Kwe-Transient Ischemic Attack: A Health for Scientic State (Eastert Professional)
• I-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, ukuhlola okuphuthumayo kochwepheshe kanye nezinqubo zokucabanga).
• I-European Stroke Organization (ESO): Imihlahlandlela Yokuphathwa Kwe-Transient Ischemic Attack (I-European Stroke Journal, i-Fonseca et al., okuhlanganisa izincomo ezimbili zokwelashwa kwe-antiplatelet [DAPT] ezivela kuzivivinyo ze-CHANCE, POINT, ne-THALES).
• Izincomo Zokuzijwayeza Okuhle Kakhulu Zase-Canada (Isisekelo Senhliziyo Nesifo Sohlangothi sase-Canada): Ukuvinjelwa Kwesibili Kwesifo Sohlangothi kanye Nezimo Zesikhashana Ze-Ischemic Attack kanye Nemihlahlandlela Yokulawulwa Kwezimo Eziphuthumayo.
• Inhlangano Yezempilo Yomhlaba (i-WHO) kanye Nenhlangano Yomhlaba Wonke Ye-Stroke (WSO): Imihlahlandlela Yomhlaba Wonke Ye-Stroke kanye Nohlelo Lokusebenza Lwe-Acute Cerebrovascular Triage.

Iziqondiso ezihlobene¶

• Ukuqashelwa kwesifo sohlangothi (FAST) kanye nempendulo ephuthumayo
• Ukukhubazeka kobuso: ukuhlukanisa ukukhubazeka kuka-Bell nokushaywa yisifo sobuchopho
• I-subarachnoid hemorrhage, ukuduma kwekhanda, kanye ne-aneurysm yobuchopho ephukile
• Isimo esiphuthumayo somfutho wegazi ophezulu ngokumelene nokuphuthuma: lapho umfutho wegazi udlula ku-180/120
• Izimo eziphuthumayo zesifo sikashukela: i-hypoglycemia kanye ne-hyperglycemia usizo lokuqala