Transient Ischemic Attack (TIA) is a common acute cerebrovascular disorder. It presents as focal neurological dysfunction caused by temporary hypoperfusion in the carotid system, vertebrobasilar system, or both arterial territories. TIA is widely recognized as a critical warning sign for subsequent stroke.
Etiological Factors
Six major causes are acknowledged in modern clinical practice:
1. Microembolism
Emboli mainly originate from atherosclerotic plaque fragments in extracranial arteries, composed of cholesterol, cellulose and platelet aggregates. This type of lesion usually leads to recurrent and stereotyped TIA episodes.
2. Hemodynamic changes
In patients with cerebral arteriosclerosis, sudden transient hypotension or postural orthostatic hypotension can trigger TIA. This cause is more frequently seen in vertebrobasilar system TIA.
3. Cervical arterial compression and deformation
Elongation, tortuosity or kinking of cervical arteries, as well as vertebral artery compression by osteophytes due to cervical spondylosis, can induce ischemic symptoms when the patient turns the neck.
4. Cardiac dysfunction
Arrhythmia, atrioventricular block and acute myocardial infarction reduce cerebral blood perfusion locally and bring on TIA.
5. Hypercoagulability and platelet aggregation
Abnormal blood hypercoagulable state and excessive platelet accumulation increase the risk of vascular occlusion and transient cerebral ischemia.
6. Cerebral vasospasm
Spasm of intracranial arteries narrows the vascular lumen and decreases cerebral blood flow, resulting in temporary neurological deficits.
Clinical Diagnostic Criteria
Clinical manifestations depend on the location of ischemic lesions. TIA is divided into carotid system TIA and vertebrobasilar system TIA.
Carotid system TIA
Typical symptoms include contralateral mild hemiplegia, hemisensory disturbance, aphasia, visual impairment and hemianopia. Symptoms last from several minutes to hours and resolve completely. Neurological examination returns to normal during intervals. Physical examination may detect cervical vascular murmurs and weakened carotid pulsation. Carotid angiography and cervical Doppler ultrasound are effective auxiliary diagnostic tools.
Vertebrobasilar system TIA
This type is more common among elderly people. Main manifestations include occipital headache, transient visual disturbance and visual field defects, accompanied by brainstem symptoms such as diplopia, vertigo, dysarthria, dysphagia, facial numbness, ataxia and crossed hemiplegia. Drop attack — sudden limb weakness with preserved consciousness — is a typical symptom. Symptoms triggered by neck rotation are mostly related to vertebral artery compression caused by cervical spondylosis.
Core diagnostic standard: All neurological deficits caused by cerebral ischemia fully resolve within 24 hours.
Acupuncture Treatment
1. Body Acupuncture Protocol
(1) Hegu (LI4, Affected Side)
Location: On the dorsum of the hand, between the 1st and 2nd metacarpal bones, at the midpoint of the radial side of the 2nd metacarpal bone.
Needling: Use a 30-gauge, 2-inch filiform needle. After standard disinfection, insert obliquely 45 mm toward Xiangu (SI3). Sensation: Local distension and soreness.
(2) Quchi (LI11, Affected Side)
Location: With elbow flexed, in the depression lateral to the radial end of the elbow crease, at the midpoint of the line connecting Chize and the lateral epicondyle of humerus.
Needling: Use a 30-gauge, 2-inch filiform needle. After disinfection, insert obliquely 45 mm toward Shaohai (HT3). Sensation: Local distension and soreness.
(3) Qiuxu (GB40, Affected Side)
Location: On the dorsum of the foot, anterior and inferior to the lateral malleolus, in the depression lateral to the extensor digitorum longus tendon, directly facing the 4th interdigital space.
Needling: Use a 28-gauge, 2-inch filiform needle. Insert 33 mm along the bone suture after disinfection. Sensation: Local distending and stabbing pain.
(4) Zusanli (ST36, Affected Side)
Location: 75 mm below Dubi (ST35), one middle-finger breadth lateral to the anterior crest of the tibia.
Needling: Use a 30-gauge, 2-inch filiform needle. Insert perpendicularly 45 mm after disinfection. Sensation: Local soreness, or radiating distension toward the dorsum of the foot.
(5) Fengchi (GB20, Affected Side)
Location: Below the occiput, in the depression between the upper borders of sternocleidomastoid and trapezius muscles, level with Fengfu (GV16).
Needling: Use a 30-gauge, 2-inch filiform needle. Insert obliquely 40 mm toward the spinal column after disinfection. Sensation: Local distension and soreness.
Operation Method
The patient takes a sitting or lateral recumbent position. Retain needles for 40 minutes with twice manual manipulation during retention. Treatment is given once a day. Ten sessions form one course, with a 5-day rest before the next course.
2. Scalp Acupuncture Protocol
(1) Motor Area (Unaffected Side)
Location: The upper point is 5 mm posterior to the midpoint of the anterior-posterior midline (from glabella to external occipital protuberance). The lower point is the intersection of the eyebrow-occipital line and the anterior hairline at the temple. The connecting line is the motor area: the upper 1/5 corresponds to lower limbs, the middle 2/5 to upper limbs, and the lower 2/5 to the face.
Needling: Use three 30-gauge, 1.5-inch filiform needles. Apply rapid insertion method, advance needles beneath the epicranial aponeurosis and reach the required depth along the skull. Sensation: Local distending and stabbing pain.
(2) Sensory Area (Unaffected Side)
Location: A parallel line 15 mm posterior to the motor area. Regional division and needling method are the same as the motor area.
Operation Method
The patient sits upright. Select corresponding areas according to symptoms: only the upper 1/5 area is chosen for simple lower limb motor and sensory sequelae, and so on. Retain needles for 60 minutes, manipulate needles at a frequency of 200 times per minute every 20 minutes. Press the pinhole gently after needle withdrawal to prevent bleeding. Treatment is administered once a day. Ten sessions make one course, with a 5-day interval between courses.
Clinical Comments
Most TIA patients recover completely with vasodilator medications without sequelae. However, some patients, especially those caused by microembolism, may suffer from persistent numbness of limbs, decreased muscle strength, dysarthria, poor concentration and dizziness. Early acupuncture intervention achieves excellent therapeutic effects on TIA sequelae, and scalp acupuncture delivers particularly prominent results. Most patients can regain full function with timely standardized acupuncture treatment.