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一過性脳虚血発作(TIA)の最近の考え方 −早期検査・治療の必要性について−

New clinical concept of TIA The need for urgent evaluation and immediate initiation of treatment

河野 威
Takeshi Kohno

Key words: 一過性脳虚血発作,拡散強調画像,頸動脈内膜剥離術,内頚動脈狭窄,ABCD2スコア
Keywords: transient ischemic attack, diffusion weighted image, carotid endarterectomy, internal carotid artery stenosis, ABCD2 score
要旨
近年MRIの拡散強調画像(DWI)による脳虚血巣の早期検出が可能になり,かつ欧米
における脳卒中の精力的な疫学研究により,一過性脳虚血発作(TIA)の概念や治療が大きく変わりつつある。従来の定義は「24時間以内に消失する局所神経症状」とされてきたが,それらの多くはDWIで既に梗塞巣を持っており,TIAと急性脳梗塞との明確な区別ができなくなった。またTIAの中に早期に脳梗塞を再発する患者群が存在することも明らかとなり(ハイリスクTIA),結果後遺症を残すことになるため,TIAの段階で検査・治療を開始すればその殆どは脳梗塞への進展が予防できることも明らかとなった。ハイリスクTIAと急性脳梗塞を同じスペクトラム上のものと捉え急性脳血管症候群(Acute CerebrovascularSyndrome:ACVS)という新しい臨床概念が提唱されている。

Abstract: In recent years, the early detection of a brain ischemic lesion has been enabled by MRI diffusion weighted Imaging (DWl); in addition, over the past ten years, epidemiological studies of strokes were diligently carried out in Europe and America, and, as a result, the concept and treatment of transient
ischemic attack (TIA) is changing greatly. The traditional definition of TIA is “focal neurological symptoms that disappeared within 24 hours”. But many traditional TIAs have an ischemic lesion already in DWl, therefore, the clear distinction between TIA and an acute stroke is no longer easy to determine.
On the other hand, some groups of TIA patients (high risk TIA) risk strokes early after TIA and will have a sequela. In addition, recent studies have shown that stroke risk in the first few days after TIA is high. It became obvious that if the examination and treatment were to be initiated immediately, the risk of having a stroke can almost be prevented. This new clinical concept is termed acute cerebrovascular syndrome (ACVS), which includes acute TIA and acute ischemic stroke.
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