WordNet

the act of attacking; "attacks on women increased last year"; "they made an attempt on his life" (同)attempt
(military) an offensive against an enemy (using weapons); "the attack began at dawn" (同)onslaught, onset, onrush
a decisive manner of beginning a musical tone or phrase (同)tone-beginning
an offensive move in a sport or game; "they won the game with a 10-hit attack in the 9th inning"
strong criticism; "he published an unexpected attack on my work"
a sudden occurrence of an uncontrollable condition; "an attack of diarrhea"
begin to injure; "The cancer cells are attacking his liver"; "Rust is attacking the metal"
set to work upon; turn ones energies vigorously to a task; "I attacked the problem as soon as I got out of bed"
the onset of a corrosive or destructive process (as by a chemical agent); "the film was sensitive to attack by acids"; "open to attack by the elements"
attack in speech or writing; "The editors of the left-leaning paper attacked the new House Speaker" (同)round, assail, lash out, snipe, assault
take the initiative and go on the offensive; "The Serbs attacked the village at night"; "The visiting team started to attack" (同)aggress
launch an attack or assault on; begin hostilities or start warfare with; "Hitler attacked Poland on September 1, 1939 and started World War II"; "Serbian forces assailed Bosnian towns all week" (同)assail
(physics) a short-lived oscillation in a system caused by a sudden change of voltage or current or load
one who stays for only a short time; "transient laborers"
relating to or affected by ischemia (同)ischaemic

PrepTutorEJDIC

…'を'『襲う』,『攻撃する』;(ゲームで)…'を'攻める / (演説・文書などで)…'を'『非難する』,攻撃する / 〈病気・不運などが〉…'を'襲う,冒す / 〈仕事など〉‘に'勢いよく取りかかる,着手する / 『攻撃をする』 / 〈U〉〈C〉(…に対する)『攻撃』;(ゲームの)攻め;非難《+『on』(『upon, against』)+『名』》 / 〈C〉発病,発作 / 〈U〉(仕事への)着手,開始
(また transitory)一時の,つかの間の,はかない / (人が)短期滞在の / (ホテルなどの)短期滞在客

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/18 10:27:09」(JST)

wiki en

A transient ischemic attack (TIA) is a transient episode of neurologic dysfunction caused by ischemia (loss of blood flow) – either focal brain, spinal cord or retinal – without acute infarction (tissue death). TIAs have the same underlying cause as strokes: a disruption of cerebral blood flow (CBF), and are frequently referred to as mini-strokes. TIAs and strokes cause the same symptoms, such as contralateral paralysis (opposite side of body from affected brain hemisphere) or sudden weakness or numbness. A TIA may cause sudden dimming or loss of vision (amaurosis fugax), aphasia, slurred speech (dysarthria) and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or 24 hours. Brain injury may still occur in a TIA lasting only a few minutes. Having a TIA is a risk factor for eventually having a stroke or a silent stroke.^[1]^[2] A silent stroke or silent cerebral infarct (SCI) differs from a TIA in that there are no immediately observable symptoms. A SCI may still cause long lasting neurological dysfunction affecting such areas as mood, personality and cognition. A SCI often occurs before or after a TIA or major stroke.^[3]

A cerebral infarct that lasts longer than 24 hours but fewer than 72 hours is called a reversible ischemic neurologic deficit or RIND.

Signs and symptoms

Symptoms vary widely from person to person, depending on the area of the brain involved. The most frequent symptoms include temporary loss of vision (typically amaurosis fugax); difficulty speaking (aphasia); weakness on one side of the body (hemiparesis); and numbness or tingling (paresthesia), usually on one side of the body. Impairment of consciousness is very uncommon. There have been cases of temporary and partial paralysis affecting the face and tongue of the afflicted. The symptoms of a TIA are short-lived and usually last a few seconds to a few minutes and most symptoms disappear within 60 minutes. Some individuals may have a lingering feeling that something odd happened to the body. Dizziness, lack of coordination or poor balance are also symptoms related to TIA. Symptoms vary in severity.

Causes

The most common cause of a TIA is an embolus that occludes an artery in the brain. This usually arises from a dislodged atherosclerotic plaque in one of the carotid arteries (i.e. two of the four major arteries supplying the brain) or from a thrombus (i.e. a blood clot) in the heart because of atrial fibrillation. In a TIA, the blockage period is very short-lived and hence there is no permanent damage.^[4] The cholesterol build-up is gradual and eventually narrows the lumen. With time, blood flow to that side of the brain is reduced and a stroke may result. In other cases, cholesterol particles from the atherosclerotic plaque may suddenly break off and enter the brain. In some people, these fragments come off from the heart and go to the brain. This often happens during a heart attack or an infection of the valves.^[5]

Other reasons include excessive narrowing of large vessels resulting from an atherosclerotic plaque and increased blood viscosity caused by some blood diseases. TIA is related to other medical conditions such as hypertension, heart disease (especially atrial fibrillation), migraine, cigarette smoking, hypercholesterolemia, and diabetes mellitus.

Risk factors

Family history of stroke or TIA substantially increases risk.
People 55 years or older are at higher risk.
Males have a slightly higher risk of TIA than females but females are more likely to die from a stroke.
High blood pressure
Diabetes Mellitus
African Americans generally tend to have a high risk of dying from a stroke, chiefly due to high blood pressure and uncontrolled diabetes.^[6]

Diagnosis

TIA will usually be diagnosed after a doctor performs a history and a physical exam. There are several radiological tests that are done to evaluate patients who have had a TIA. This includes a CT scan or an MRI of the brain, ultrasound of the neck, an echocardiogram of the heart. In most cases, the source of atherosclerosis is usually identified with an ultrasound.^[7]

Differential diagnoses

Other diagnoses may have symptoms similar to those of a TIA:

Atypical migraine if visual symptoms occur such as perception of wavy or jagged lines or tiny specks of light and if a headache occurs.^{[citation needed]} Typically a history of prior migraines is present.
Partial seizure in the parietal area of the brain
Glucose abnormalities; these could be distinguished by a history of diabetes mellitus and a loss of consciousness
Electrolyte abnormalities
Hypertensive encephalopathy (headache, delirium, hypertension, cerebral edema)
Subdural hematoma (history of trauma, headache, loss of consciousness)
Brain tumor (mode of onset, progressive headaches, increased intracranial pressure)
Demyelinating disease
Conversion disorder

Prevention

A TIA may be prevented by changes in lifestyle; although most of these recommendations have no solid empirical data, most medical professionals believe them to be so.^[8] These include:

Avoiding smoking
Cutting down on fats and cholesterol to help reduce plaque build up
Eating a healthy diet including plenty of fruits and vegetables
Limiting sodium in the diet, thereby reducing blood pressure
Exercising regularly
Moderating alcohol intake
Maintaining a normal weight
Controlling blood pressure and keeping blood sugars under control

Treatment

The mainstay of treatment following acute recovery from a TIA should be to diagnose and treat the underlying cause. It is not always immediately possible to tell the difference between a CVA (stroke) and a TIA. Most patients who are diagnosed at a hospital's emergency department as having suffered from a TIA will be discharged home and advised to contact their primary physician to organize further investigations. A TIA can be considered as the last warning. The reason for the condition should be immediately examined by imaging of the brain. Occasionally, none of these tests will determine the cause, but the symptoms show that the stroke did occur.

The initial treatment is aspirin, second line is clopidogrel (PLAVIX), third line is ticlopidine. If TIA is recurrent after aspirin treatment, the combination of aspirin and dipyridamole is needed (Aggrenox).

An electrocardiogram (ECG) may show atrial fibrillation, a common cause of TIAs, or other arrhythmias that may cause embolisation to the brain. An echocardiogram is useful in detecting thrombus within the heart chambers. Such patients benefit from anticoagulation.

If the TIA affects an area supplied by the carotid arteries, an ultrasound (TCD) scan may demonstrate carotid stenosis. For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a carotid endarterectomy, may be recommended. The blood vessel is opened up and the plaque is removed. The carotid may be replaced with a vessel retrieved from the lower leg or foot. The procedure is not technically difficult but carries the potential complication of inducing a stroke. A stroke can occur during surgery or after the procedure. The chance of a stroke ranges from 1–4 percent.^[9]

Some patients may also be given modified-release dipyridamole or clopidogrel.

Medication

The use of anti-coagulant medications, heparin and warfarin, or anti-platelet medications such as aspirin may be warranted. Antiplatelet drugs prevent platelets from agglutinating or sticking to each other, hence the term "blood thinner." Thinning the blood helps to ensure that small particles do not form and travel to the brain. These drugs require frequent monitoring. These drugs also have side effects such as easy bruising and bleeding from mild trauma.^[10]

Prognosis

People diagnosed with a TIA are sometimes said to have had a warning for an approaching stroke. If the time period of blood supply impairment lasts more than a few minutes, the nerve cells of that area of the brain die and cause permanent neurologic damage. One third of the people with TIA later have recurrent TIAs and one third have a stroke because of permanent nerve cell loss. Other sources cite that 10% of TIAs will develop stroke within 90 days, half of which will occur in the first two days following the TIA.^{[citation needed]} The risk of a stroke occurring after a TIA can be predicted using the ABCD² score.

References

^ Ferro JM et al. Diagnosis of transient ischemic attack by the nonneurologist. A validation study. 1996 Dec;27(12):2225–9.PMID 8969785
^ Easton JD. et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.Stroke. 2009 Jun;40(6):2276–93. Epub 2009 May 7.PMID 19423857
^ Coutts SB, et al. Silent ischemia in minor stroke and TIA patients identified on MR imaging. Neurology. 2005 Aug 23;65(4):513–7.PMID 16116107
^ What is a TIA or transient ischemic attack? American Heart Association. Retrieved on 2010-03-07^{[dead link]}
^ Transient Ischemic Attack MedLine Plus. Retrieved on 2010-03-07
^ African Americans and Stroke National Stroke Association. Retrieved on 2010-03-07
^ Transient Ischemic Attack eMedicine. Retrieved on 2010-03-07
^ UK National Health advice
^ Transient Ischemic Attacks(TIA) Merck, Sharpe & Dohme. Retrieved on 2010-03-07
^ Brain Stroke Overview Retrieved on 2010-03-07

External links

UpToDate Contents

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1. 一過性脳虚血発作および軽症脳卒中の一次評価および管理 initial evaluation and management of transient ischemic attack and minor stroke
2. 一過性脳虚血発作の病因および臨床症状 etiology and clinical manifestations of transient ischemic attack
3. 一過性脳虚血発作の定義 definition of transient ischemic attack
4. 虚血性脳卒中および一過性脳虚血発作の特定の原因に対する二次予防 secondary prevention for specific causes of ischemic stroke and transient ischemic attack
5. 一過性脳虚血発作および脳卒中の鑑別診断 differential diagnosis of transient ischemic attack and stroke

English Journal

Biomarkers and Mortality After Transient Ischemic Attack and Minor Ischemic Stroke: Population-Based Study.

Greisenegger S1, Segal HC1, Burgess AI1, Poole DL1, Mehta Z1, Rothwell PM2.
Stroke; a journal of cerebral circulation.Stroke.2015 Feb 3. pii: STROKEAHA.114.007624. [Epub ahead of print]
BACKGROUND AND PURPOSE: Premature death after transient ischemic attack or stroke is more often because of heart disease or cancer than stroke. Previous studies found blood biomarkers not usefully predictive of nonfatal stroke but possibly of all-cause death. This association might be explained by p
PMID 25649803

Prediction of myocardial infarction in patients with transient ischaemic attack.

Vilanova MB1, Mauri-Capdevila G, Sanahuja J, Quilez A, Piñol-Ripoll G, Begué R, Gil MI, Codina-Barios MC, Benabdelhak I, Purroy F.
Acta neurologica Scandinavica.Acta Neurol Scand.2015 Feb;131(2):111-9. doi: 10.1111/ane.12291. Epub 2014 Oct 10.
BACKGROUND: Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA.METHODS: We prospectively recruited patients within 24 h of transient ischaemic cerebrovascula
PMID 25302931

Impact of aspirin according to type of stable coronary artery disease: insights from a large international cohort.

Bavry AA1, Gong Y2, Handberg EM3, Cooper-DeHoff RM4, Pepine CJ3.
The American journal of medicine.Am J Med.2015 Feb;128(2):137-43. doi: 10.1016/j.amjmed.2014.09.028. Epub 2014 Oct 15.
BACKGROUND: Aspirin is recommended in stable coronary artery disease based on myocardial infarction and stroke studies. However, benefit among stable coronary artery disease patients who have not suffered an acute ischemic event is uncertain. The objective of this study was to evaluate the impact of
PMID 25447610

Japanese Journal

(最終講義)急性脳血管症候群としての一過性脳虚血発作

内山真一郎,UCHIYAMA Shinichiro
東京女子医科大学雑誌 84(5), 140-147, 2014-10-25
NAID 120005511256

(最終講義)急性脳血管症候群としての一過性脳虚血発作

内山真一郎
東京女子医科大学雑誌 84(5), 140-147, 2014-10-25
発症後早期の一過性脳虚血発作(TIA)は脳卒中発症リスクが非常に高い危険な病態であり、救急疾患として対処する必要がある。TIAと急性虚血性脳卒中(AIS)は神経症状の持続時間のみから区別するのは意味がなく、両者は同一スペクトラム上にある病態であることから、TIAとAISを包括する急性脳血管症候群(ACVS)という概念を提唱する。発症後早期のTIAをACVSという概念に包括することにより、TIクリニ …
NAID 110009840763

最終講義急性脳血管症候群としての一過性脳虚血発作

内山真一郎
東京女子医科大学雑誌 = Journal of Tokyo Women's Medical University 84(5), 140-147, 2014-10
NAID 40020260447

Related Pictures

★リンクテーブル★

リンク元	「脳梗塞」「一過性脳虚血発作」「transient ischaemic attack」「transient cerebral ischemic attack」「transient cerebral ischemia」
拡張検索	「lacunar transient ischemic attack」
関連記事	「attack」「transient」「ischemic」「ischemic attack」

「脳梗塞」

Transient ischemic attack
	Classification and external resources
ICD-10	G45.9
ICD-9	435.9
DiseasesDB	13253
MedlinePlus	000730
eMedicine	emerg/604
MeSH	D002546

　　[★]

英: cerebral infarction, brain infarction
関: 一過性脳虚血発作 transient ischemic attack TIA
関: 脳塞栓症、脳血栓症

神経系 091015II(脳梗塞における血液マーカー),091016III,091016IV

疫学

脳卒中に占める割合：アテローム血栓性梗塞24.1%、ラクナ梗塞22.7%、心原性脳塞栓症19.2%、その他の脳梗塞5.1% (ガイドライン1)

分類

アテローム血栓性脳梗塞

定義：脳を灌流する頭蓋内外の主幹動脈のアテローム硬化を原因とする梗塞
機序：塞栓性、血栓性、血行力学性

血栓性：アテロームプラークの破綻→血管内皮下組織への血小板の付着→血小板活性化・凝集→(主に)血小板凝集塊の形成
血行力学性：主幹動脈の狭窄や閉塞

好発部位：内頚動脈(起始部、サイフォン部)、中大脳動脈(水平部)、後大脳動脈(近位部)、椎骨動脈(起始部、終末部)、脳底動脈
危険因子：高血圧、糖尿病、高脂血症

心原性脳塞栓

定義：心臓内の栓子や心臓を経由する栓子が急激に脳動脈を閉塞する
機序：塞栓性

塞栓性：血液うっ滞→血液凝固カスケードの活性化→トロンビン生成の亢進→フィブリン形成の進展

合併：出血脳梗塞(高率に移行)

ラクナ梗塞　高血圧と関連

定義：一本の穿通枝動脈閉塞による直径1.5cm未満の小さな梗塞
機序：細小動脈硬化、微小塞栓、血栓・塞栓症、血行力学性

細小動脈硬化：高血圧に対抗してリポヒアリノーシス(微小動脈硬化・血管硬化)が起こり血管が狭窄
微小塞栓：脳内外の微少な塞栓物質による
穿通枝動脈の微小粥腫
穿通枝分岐部の分枝粥腫(cf.branch atheromatous disease, BAD)→穿通枝動脈が起始部から閉塞して起こる

危険因子：高齢、高血圧
好発部位：基底核、比較、橋、支障、内包後脚、側脳室外側の大脳深部白質

比較

SQ.515

	アテローム血栓性脳梗塞	ラクナ梗塞	心原性脳塞栓
発症機序	血栓性塞栓性血行力学性	血栓症	塞栓性
好発年齢	高齢者	高齢者	若年者もあり
発症時刻	起床時	覚醒時	日中活動時
発症様式	緩徐進行	比較的緩徐進行	突発的
意識障害	軽度	なし	しばしば高度
大脳皮質症状	時にあり	なし	あり
基礎疾患	高血圧糖尿病高脂血症	高血圧	心疾患

リスクファクター

高血圧、心筋梗塞、心房細動、糖尿病、高脂血症、無症候性頚動脈病変

血圧：(脳梗塞全般)140/90mmHg以上。(ラクナ梗塞)130/85mmHg以上

生活習慣因子

喫煙、飲酒、身体活動性、食事

検査

画像検査では超急性期には拡散強調画像が有用。CTではearly CT signを確認する。

CT

early CT sign

http://melt.umin.ac.jp/ct/melt_ct_02a.htm

発症2日後：[show details]

MRI

拡散強調画像：超急性期で梗塞部が高信号を呈する。
T1：急性期以降(1日～)に低信号
T2：6時間以降に高信号を呈する(細胞腫脹)。

治療

治療 YN.J-81
時期	ラクナ梗塞	アテローム血栓性脳梗塞	心原性塞栓症
超急性期(～3時間)	血栓溶解療法(t-PA静注)
超急性期＋急性期	脳保護薬(エダラボン)
急性期(～2週間)	抗血小板療法(アスピリン)
	抗血小板療法(オザグレル)		抗凝固療法(ヘパリン、ワルファリン)
		選択的トロンビン阻害薬(アルガトロバン)
	抗浮腫療法(グリセロール)

予後

ガイドライン1

入院時NIH Stroke Scale（NIHSS）スコアの中央値：ラクナ梗塞4、アテローム血栓性脳梗塞6、心原性脳塞栓症14、その他5
退院時のmodified Rankin Scale(mRS)3-5の転帰不良(及び死亡)の割合：ラクナ梗塞22.6％（死亡率1.1％）、アテローム血栓性脳梗塞41.4％(6.9％)、心原性脳塞栓症44.8％(18.6％)、29.8％(10.3％)
重症度：心原性脳塞栓症＞アテローム血栓性脳梗塞＞ラクナ梗塞

国試

097D043、099F041、100F049、099A043、096C016、098A043

ガイドライン

1. 脳卒中治療ガイドライン2009

http://www.jsts.gr.jp/jss08.html

「一過性脳虚血発作」

　　[★]

英: transient cerebral ischemic attack, transient ischemic attack TIA
同: ~~temporary ischemic attack~~　←　誤用なのでは？
関: 脳卒中、一過性神経発作 TNA

	内頚動脈系	椎骨脳底動脈系
運動障害	一側	一側/両側
感覚障害	一側	一側/両側
視力障害	一過性黒内障	中心回避型視野欠損
小脳症状	なし	運動失調・動揺歩行
脳神経症状	稀	構音・嚥下障害、複視
自覚症状	失語	回転性めまい、両眼がかすむ、嘔吐
発作回数/症候	少ない/同一	多い/変動
梗塞への移行	多い	少ない
関連血管	眼動脈、中大脳動脈	後大脳動脈、SCA、AICA、PICA