MEDIX, God. 14 Br. 79  •  Pregledni članak  •  Neurologija HR ENG

Algoritam zbrinjavanja bolesnika s TIA-omThe algorithm for treatment of patients with TIA

Ivo Lušić

Tranzitorna ishemijska ataka (TIA) je krvožilno prouzročena akutna epizoda prolazne žarišne cerebralne disfunkcije trajanja kraćeg od 24 sata. Bolesnici s TIA-om zahtijevaju hitnu procjenu stanja i rizika mogućih komplikacija – u prvom redu rizika za nastup moždanog udara. Prema općeprihvaćenim smjernicama, uz anamnezu te standardni fizikalni i neurološki pregled, svi bolesnici s TIA-om trebali bi kao minumum žurne obrade izvršiti snimanje CT-a mozga, EKG-a, kao i standardne biokemijske i hematološke pretrage. Premda postoje određene dvojbe, ovim bi pretragama bilo uputno pridružiti i ehosonografske pretrage velikih krvnih žila aortnog luka. Naravno, postoji i niz drugih mogućih pretraga koje se indiciraju ovisno o pretpostavljenom uzroku TIA-e, o podacima iz anamneze, o spolu i dobi bolesnika, kao i o nizu drugih čimbenika. Također, postoji konsenzus da se bolesnicima s TIA-om nekardioembolijskog uzroka treba odmah ordinirati antiagregacijsko liječenje, kao i da u bolesnika s kombinacijom TIA-e i atrijske fibrilacije treba primijeniti anitkoagulacijske lijekove. Za sada ne postoji jedinstven stav u pogledu potrebe za hitnom hospitalizacijom svih bolesnika s TIA-om, premda postoje jasne odrednice za određena stanja – u kojima je hospitalizacija neizbježna

Ključne riječi:
dijagnostičke tehnike i postupci; tranzitorna ishemijska ataka; terapija

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 14 Br. 79

Transitory ischaemic attack (TIA) is an acute episode of focal transitory cerebrovascular dysfunction that lasts up to 24 hours. Patients with symptoms suggestive of TIA require an urgent evaluation of both their condition and possible risk of complications, primarily stroke. The current guidelines and available evidence recommend that all patients with TIA should undergo brain computed tomography (CT), electrocardiographic evaluation, and standard biochemical and blood laboratory tests. Ultrasound of aortic arch vessels may also be performed. There are also other possible diagnostic procedures that may be performed depending on the suspected cause of TIA, patient history, sex and age and a range of other factors. The consensus is that patients with non-cardioembolic causes of TIA should receive antiplatelet therapy and that TIA patients with atrial fibrillation should receive anticoagulation therapy. Prompt imaging of the carotid arteries to detect stenosis greater than 70% should be performed, since urgent carotid endarterectomy is believed to be most beneficial in this group of patients. However, the optimal timing of endarterectomy in patients with high-grade carotid stenosis is unclear. Generally, guidelines recommend hospitalization of patients with new onset TIA if it is not possible to urgently perform imaging studies, such as carotid Doppler. However, in a separate review of TIA management, hospitalization was identified as an area of uncertainty. Patient management in a setting such as an emergency department observation unit is suggested as a more cost effective alternative.

Key words:
diagnostic techniques and procedures; ischemic attack, transitory; therapy