Have you ever had a transient ischemic attack (TIA)? Before you answer, consider the facts. An estimated five million Americans have had a TIA, but only about half of them realized what was happening. That's because the symptoms of a TIA (a temporary interruption of blood flow to the brain can be fleeting and often are ignored. And unlike a stroke, a TIA does not cause permanent brain injury. (To learn more about TIA symptoms, take the quiz on the next page.)
Frightening statistic: Anyone who has had a TIA is 10 times more likely to have a full-blown stroke.
When To Call 911
A TIA occurs when an area of the brain doesn't get enough blood, often due to a narrowing or blockage of an artery leading to the brain. TIA symptoms, which are the same as those for a stroke, can be subtle and sometimes last just a few minutes. They include…
- Sudden difficulty with walking or maintaining balance.
- Sudden weakness or numbness affecting an arm or leg on one side of the body.
- Sudden difficulty speaking or understanding speech.
- Sudden vision loss in one eye or difficulty seeing to one side.
Important: If you're having any of these symptoms, call 911. There's no way for a patient to tell if the symptoms are due to a TIA or a stroke.
Many people who have a TIA-or even suspect one-do not see a doctor. Now, an additional problem has been discovered.
Important research finding: About one in three people who visited a primary care physician after having TIA symptoms did not receive a stroke-related evaluation, including such tests as a computed tomography (CT) scan during the next 30 days. This means such people may be missing a valuable opportunity to begin treatment that could prevent a major stroke.
Key Risk Factors
You're more likely to suffer a TIA or stroke if you are overweight or inactive and/or have high blood pressure, elevated cholesterol or diabetes. TIA and stroke risk also are increased by age a person's stroke risk doubles every decade after age 55)...family history (having a parent or sibling who had a stroke before age 65)...and gender (men are at greater risk for stroke than women, but most stroke deaths occur in women).
If you have TIA symptoms that last for more than a few minutes, call 911. If they quickly resolve, ask someone to drive you to the closest emergency room as soon as possible and tell the personnel that you may be having a stroke.
What most people don't know: Patients who are immediately evaluated and treated after experiencing TIA symptoms have fewer full-blown strokes than TIA sufferers who don't receive prompt care.
Get A Proper Evaluation
If you have what appear to be TIA symptoms, taking the right actions can dramatically impact your long-term health. The cause of your symptoms must be determined-other health problems, such as diabetes or a brain tumor, can trigger TIA-like symptoms. If you've had a TIA, the underlying problem, such as a blood clot or a tear in a blood vessel, must be determined. Steps should include…
- Immediate evaluation. At the hospital, tests typically include a complete blood count (CBC), blood glucose measurement, a urinalysis, an electrocardiogram (EKG) and a brain imaging study, such as a CT scan.
- Specific tests. Depending on your case, other tests, such as a magnetic resonance imaging (MRI scan, may be used to determine if there is a blockage in one of the arteries that supply the brain.
If atrial fibrillation (a disturbance in the electrical rhythms of the heart that can generate stroke-causing blood clots) is suspected but not detected on the initial EKG, it may be necessary to wear a heart monitor for a day to rule out the presence of intermittent atrial fibrillation. An echocardiogram (an ultrasound of the heart) also may be performed.
Best Treatment Options
People who have had a TIA—as well as those who have not-may be able to reduce their stroke risk by adopting these habits…
- Eat a diet low in saturated fats (found in red meat and full-fat dairy products) with at least three to five daily servings of fruits and vegetables...exercise at a brisk pace (such as fast walking) 20 to 30 minutes a day most days of the week.. avoid excessive alcohol intake (no more than two drinks a day for men and one drink a day for women)...stop smoking (and avoid secondhand smoke). For a healthy body weight, aim for a body mass index (BMI) of 25 or lower.
- Blood thinners. If tests show that you have atrial fibrillation, your doctor will probably prescribe a blood thinner, such as warfarin (Coumadin). Other medications—known as antiplatelet drugs-may help reduce stroke risk in high-risk people without atrial fibrillation. These drugs include aspirin, the antiplatelet drug clopidogrel (Plavix) and a combination of aspirin and dipyridamole (Aggrenox).
Warning: The combination of aspirin and Plavix can increase the risk for a hemorrhagic stroke (caused by bleeding in the brain) in patients who have had a stroke or a TIA, so be sure your doctors know about all the medications you take, including aspirin.
- Cholesterol-lowering "statin" drugs. In a study of nearly 5,000 people who have had a TIA or stroke, those with an LDL "bad" cholesterol level of 100 mg/dL to 190 mg/dL who took atorvastatin (Lipitor) had a 16% drop in risk for a subsequent nonfatal or fatal stroke, compared with a placebo group.
- Blood pressure-lowering medication. Lowering blood pressure by an average of 10 points systolic (top number) and 5 points diastolic (bottom number) can reduce risk for a post-TIA stroke by nearly 40%.
- Surgery. If there is a narrowing of the carotid (neck) artery that could have caused your symptoms, you may need an endarterectomy, a surgical procedure that removes artery-blocking plaque. In some circumstances (such as narrowing of the carotid artery in an area that is difficult for the surgeon to reach), your doctor may recommend inserting a stent, a tube that helps keep the blood vessel open.
Take This Quick TIA Quiz
Up to one-third of TIA sufferers will eventually have a stroke-unless their underlying conditions are aggressively treated. The risk for a full-blown stroke in a person who has had a TIA can be estimated by a tool that uses key factors to determine an "ABCD2" score…
- Age. If over age 60-1 point.
- Blood pressure. If your systolic blood pressure (top number) is higher than 140 mmHg and/or your diastolic blood pressure (bottom number) is higher than 90—1 point.
- Clinical features. If you had weakness on one side of your body-2 points. If you had a speech disturbance without weakness-1 point.
- Duration of symptoms. If TIA symptoms lasted for 10 to 59 minutes-1 point. If symptoms lasted for 60 minutes or longer-2 points.
- Diabetes. If you have diabetes-1 point. If your score is 4 or less, your risk for stroke within two days of a TIA is 1%...and 3% within 90 days. A score of 5 or greater indicates an 8% risk for stroke within two days...and an 18% risk within 90 days.
MRIs Reveal Real Stroke Risk
When researchers reviewed magnetic resonance imaging (MRI) scans for 2,040 adults (average age 62) who had no stroke symptoms, they found silent cerebral infarctions (SCISbrain lesions that occur when clots interrupt blood flow to the brain yet do not result in noticeable symptoms-in 10.7% of the adults. These participants did suffer some brain damage, such as loss of mental skills.
Self-defense: If you have risk factors for stroke, such as atrial fibrillation (irregular heartbeat), high blood pressure, diabetes or heart disease, ask your doctor about lifestyle modifications and treatment options to reduce your risk.
“Silent” Stroke Danger
Researchers analyzed data for 1,423 patients hospitalized for sudden sensorineural hearing loss—sudden, unexplained hearing loss, and 5,692 patients (mostly middle-aged or older) who were hospitalized for appendix removal.
Result: The hearing loss patients were 15 times more likely to suffer a stroke over the next five years than the appendectomy patients.
Theory: Sudden, unexplained hearing loss and stroke may share a common cause.
If you have sudden hearing loss: Ask your doctor whether you should have a neurological exam and blood tests to evaluate your stroke risk.
High Blood Pressure Triples Risk for Vision Loss
With retinal vein occlusion (RVO), blood vessels in the eye become blocked and may rupture, damaging eyesight.
New finding: Having high blood pressure more than tripled a person's risk for RVO...high cholesterol more than doubled RVO risk.
Best: Get regular eye exams, and control blood pressure and cholesterol.