Microudar (small stroke, mini-stroke) is a problem that is less serious than the "classic" stroke, but it should never be underestimated - in a large number of patients, the appearance of a microbead is preceded by a full-blown stroke. What are the causes of a micro-stroke and how does it manifest itself? What is the diagnosis and treatment of a micro-stroke and - what may be of greatest interest to patients - what are the differences between a typical stroke and a minor stroke?

Mikroudar(aka small stroke, mini-stroke, transient ischemia of the brain - TIA for short) is a medical condition associated with a sudden failure of the blood supply to the brain.

The characteristic features of a microcurrent are its sudden onset, the fact that the symptoms of a mini-stroke disappear completely spontaneously and that the maximum duration of symptoms in patients does not exceed 24 hours.

Due to the fact that the symptoms of a minor stroke after some time - sometimes it is a few minutes and sometimes several hours - disappear spontaneously, patients completely ignore this condition and do not visit the doctor at all. Such a situation is extremely dangerous - the occurrence of a micro-stroke is often preceded by a full-blown stroke.

Due to the fact that some patients do not report to a doctor after a microcracker, it is difficult to accurately assess the frequency of this problem.

Overall, however, it is estimated that 1 in 3 people who experience a minor stroke will experience a stroke in the near future.

Taking into account here that in a year in Poland a stroke occurs in as many as 70,000 people, it is quite easy to estimate that even more than 20,000 Poles may experience a micro-stroke every year.

Mikroudar - reasons

The immediate cause of a micro-stroke is a temporary disturbance in the blood supply to the brain. They can result from various problems - disorders belonging to three different groups can cause impairment of cerebral blood circulation.

First of all, atherosclerosis in the vessels supplying the brain (e.g. atherosclerotic changes in the internal carotid arteries) may contribute to the occurrence of a mini-stroke.

Thrombosis is also a problem that may lead to improper blood supply to the brain - the risk of such an occurrence is primarily associated with patients suffering from cardiac diseases (such as congestive heart failure or atrial fibrillation), as well assuffering from leukemia and sickle cell anemia.

Another possible mechanism by which a minor stroke may occur is intracranial bleeding - this type of disorder is, however, the rarest cause of micro-stroke.

Mikroudar - risk factors

There are a number of different factors that can be overstrained to increase the risk of a patient suffering from a minor stroke. They are divided in two ways into modifiable and non-modifiable risk factors for microcracking. The first of the listed - i.e. the modifiable risk factors of the disease in question - include:

  • hypertension,
  • cardiological diseases (such as the aforementioned circulatory failure and atrial fibrillation, but also various heart defects),
  • carotid artery diseases (mainly atherosclerosis),
  • smoking,
  • peripheral arterial disease,
  • diabetes,
  • sedentary lifestyle,
  • high proportion of saturated fat and s alt in the diet,
  • elevated homocysteine ​​levels,
  • hypercholesterolemia,
  • excess body weight (both overweight and obese),
  • excessive alcohol consumption.

The above factors are defined as modifiable because it is possible to influence them - after all, excess body weight can be lowered, the diet can be changed, and the cholesterol level can be reduced through dietary interventions and possible pharmacotherapy.

There are, however, certain risk factors for microcracking that, unfortunately, patients have no influence on - such non-modifiable risk factors for mini-stroke are:

  • age (the risk of minor stroke increases significantly after the age of 55),
  • gender (men are at greater risk of a mini-stroke),
  • family history (if a family member has had a micro-stroke or stroke, the risk that other members of the family will also experience the problem is significantly increased).

Mikroudar - symptoms

The symptoms of a micro-stroke can be very different - it all depends on the exact part of the brain in which the transient ischemia occurs. Typically in the course of this unit, the disorders concern the parts of the brain supplied by the front part of the so-called arterial circle of the brain.

The symptoms of minor stroke are focal and - especially in English-language literature - they are abbreviated as FAST (from Face, Arms, Speech and Time). Common symptoms of the disease are:

  • paralysis of the half of the face (e.g. an eyelid may dropor the corner of the mouth on one side of the face, patients with a mini-stroke may also have difficulty smiling),
  • paralysis, and sometimes paresis of the muscles of the upper limb (leading to difficulties, for example, lifting the limb, patients with a microcracker may also experience numbness and other sensory disturbances),
  • speech disorders (the patient may mumble, which makes his speech completely incomprehensible, but he may also have difficulties understanding the speech of others),
  • dizziness,
  • imbalance,
  • visual disturbance (e.g. double-image perception and sometimes transient monocular blindness, also referred to as amaurosis fugax).

It should be emphasized here that if the patient has symptoms on one side of his body - e.g. he struggles with the drooping of the left eyelid and the weakening of the muscular strength of the left upper limb - ischemia occurred within the right hemisphere of the brain.

It is also worth adding here that the symptoms of a microcracker are focal - in its course there is no significant number of disorders, e.g. paralysis of the right leg and paralysis of the left hand with syncope, in addition, the symptoms persist for a maximum of one day.

Mikroudar - diagnostics

Sudden onset of symptoms, which may be suggestive of a microcracker, is certainly an indication for an urgent visit to a doctor. Even when the patient's complaints completely resolve spontaneously, they must never be underestimated: having a minor stroke significantly increases the risk of suffering a stroke, and what's more - it can happen in a very short time (even within the next several dozen hours).

In the diagnosis of a mini-stroke, medical history and neurological examination are mainly important. The doctor focuses on the exact symptoms that the patient has experienced, then performs a neurological examination to see if the various neurological symptoms (e.g. sensory disturbances or muscle weakness) are still present.

Later, various tests are usually ordered. They include, among others laboratory tests (such as blood counts, blood glucose levels, and levels of inflammatory markers), as well as imaging tests.

In the case of the latter, we are talking about computed tomography or magnetic resonance imaging of the head - both of the above mentioned allow not only to exclude possible cerebral bleeding, but also thanks to them it is possible to observe whether the ischemia led to any permanent changes in the brain.

Imaging examinations of the head also make it possible to exclude other possible onesthe causes of the patient's symptoms (such as a brain abscess or a brain tumor).

The ultrasound Doppler of the carotid arteries is also an important test - it allows to assess whether the possible cause of a minor stroke was atherosclerotic changes, leading to a significant narrowing of the lumen of these vessels.

The above-mentioned tests are performed for several different reasons - one of them is the need for differential diagnosis. This is what the patient's blood glucose level is used for - it is necessary to exclude, among others, hypoglycemia.

Another problem that is considered in the differential diagnosis of mini-stroke is focal seizures.

Mikroudar - estimating the risk of a stroke

As it has already been mentioned several times, a microbead significantly increases the risk of a "full" stroke in a patient. For this reason, a person who has experienced a minor stroke needs to evaluate how high the risk of developing more serious neurological disorders is. The ABCD2 scale is used for this purpose - points are awarded for:

  • age (over 60 - 1 point),
  • blood pressure value (greater than 140/90 mmHg - 1 point),
  • presence of motor symptoms on one side of the body (2 points),
  • time of occurrence of neurological deviations (less than an hour - 1 point, more than an hour - 2 points),
  • existence of a speech disorder (in the case of aphasia - 1 point),
  • comorbidities (if the patient has diabetes - 1 point).

The more points in the ABCD2 scale a patient receives, the greater the risk that a patient will soon develop a stroke.

Mikroudar - treatment

The disorder that leads to a microcracker is self-limiting, so treating people who have had a minor stroke relies on various factors that increase the risk of the disease recurring. It is for this reason that it is so important to perform a comprehensive assessment of the he alth of a patient who has experienced this disease - only after this has been done, it is possible to offer him an optimal therapy.

Basically, every person who has had a microbial stroke is treated with antiplatelet drugs - patients are recommended to take acetylsalicylic acid (or - in the case of intolerance or contraindications - other antiplatelet drugs).

In a situation where the patient suffers from cardiac arrhythmias (especially atrial fibrillation), it is advisable to start using medications that reduceblood clotting (anticoagulants).

In the treatment of micro-stroke in people who struggle with lipid disorders, it may be justified to start taking preparations from the statin group.

Optimal treatment of diseases suffered by a person after a mini-stroke is also extremely important - we are talking here about, for example, the need to maintain appropriate blood pressure values ​​in patients with arterial hypertension and optimal glycemic control in patients struggling with diabetes .

Mikroudar - prevention

It is simply impossible to completely prevent the occurrence of a micro-stroke, but the truth is that a proper lifestyle can significantly lower the risk of getting sick.

We are talking here, for example, about the use of a balanced, nutrient-rich diet with limitation of animal fats and trans fats (an example of such a beneficial diet is the Mediterranean diet), regular physical activity or trying to reduce excess body weight.

In order to reduce the risk of a minor stroke, patients should also remember about the harmful effects of various stimulants on their bodies - to reduce the risk of micro-stroke, alcohol abuse should be avoided and smoking should be refrained from.

Category:

Neurology