STORY BYBarbara Immons is 67 years old; looks 50; feels 40; and if you woke her in the middle of the night and asked her age, she would swear she is 35. But a few weeks ago, she ended up in the emergency room. The diagnosis: TIA—transient ischemic attack.
TIA represents temporary stroke warning symptoms. A stroke can be impairment of sensation, level of consciousness, balance, or voluntary motion caused by a rupture or obstruction of an artery in the brain. In short: a stroke is a brain attack. TIA is not a full-blown stroke, but mimics one.
Dr. John Y. Choi, former assistant professor of neurology and director of Neurorecovery at The University of Texas Medical School at Houston compares TIA to “angina of the brain.” He explains, “Angina involves chest pains without an immediate heart attack that, as yet, causes no permanent damage. TIA similarly has the earmarks of a stroke without the permanent damage a stroke causes.”
The good news: TIA symptoms go away. The bad news: TIA patients are the highest risk group for having a stroke. TIA symptoms typically last for only a few minutes to 24 hours at most, although this old-fashioned definition is likely to be revised to reduce TIA duration to minutes or very few hours.
TIA can present with any of a number of symptoms. Among them:
Prime candidates for TIA may be persons who:
“Don’t call a family member or your doctor. Call 911
immediately,” says Dr. Lise A. Labiche, a Cerebrovascular
Disease Fellow at the UT Medical School and a member of STAT (Stroke
Treatment Team). “The ambulance personnel will notify the
hospital that you are on the way, emergency healthcare providers
can start to work the instant you arrive.”
Labiche cautions that you should not immediately take an aspirin. The stroke team may give you one later when it determines that your episode is a non-bleeding stroke. Most often, if symptoms last longer than one to two hours, a stroke has occurred rather than a TIA. Aspirin would only increase the bleeding if you are having a hemorrhagic or bleeding stroke. She adds, “There is no proof that taking aspirin immediately improves blood flow to the brain.”
Upon arrival to the ER, the stroke team orders a CT-scan to screen the brain tissue for any evidence of new or old strokes. The only FDA- approved treatment for non-bleeding strokes is TPA, which is effective when given within three hours of symptom onset.
After this factor is ruled out, the patients may be admitted to the hospital where they receive other imaging tests, possibly including magnetic resonance angiography (MRA), magnetic resonance imaging (MRI), Doppler and EKG.
The MRI looks at the brain tissue in more detail than the CAT scan. MRA checks blood vessels in the brain to make sure they are not severely narrowed or blocked. The EKG (electrocardiogram) is an electrical recording of the heart that investigates for heart disease. A Doppler test addresses the carotid artery to see if it is narrowing.
A person having suffered a TIA is much more likely to have another TIA, a full-blown stroke, or heart attack. Choi says that one in 10 patients will suffer another TIA or stroke during the 90 days after the first TIA. Over a three-year period, such a patient will have a 25 percent risk of a stroke.
If any signs of TIA are suspected in someone who has previously been diagnosed with the disorder, they should go immediately to the emergency room, preferably in a hospital that has a stroke team. Choi cautions that if the carotid artery becomes blocked, then surgery may be indicated. “We do a study of the heart with ultrasound and telemetry since we know that, under certain conditions, the heart can cause strokes by clot formation.”
Immons had several risk factors for TIA and stroke. Her father died of a heart attack at the age of 51; he was an adult-onset diabetic. Immons suffers from high blood pressure and high cholesterol for both of which she takes medication. She also utilized hormone therapy for more than 30 years, including Prempro.
Although she works out three times a week and is not fat, she “could stand to lose ten pounds.” She could have correctly considered herself at risk for a TIA. She left the hospital with the diagnosis of “probable TIA” and an admonition to take one aspirin per day, preferably coated for a reduced chance of stomach irritation. In some cases, an aspirin alternative is prescribed, such as Plavix or Aggrenox, which functions in a similar manner to aspirin.
Choi explains that the word “probable” was in her diagnosis because “you can’t be sure a person is having these symptoms if you do not see them happen.” The tests revealed no clues. However, Immons’ husband had called home and found her to be speaking incoherently. He knew something was amiss, and took her to the ER. This speech pattern was the primary clue in her case.
In any case, the potentially devastating, disabling effects of a stroke are too great to ignore, and many good preventative therapies exist for stroke.
Immons is glad to be alive, and to have a second chance to modify her habits and increase her odds for a longer, stroke-free life.
UPDATED: 7-24-2003
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Dr. John Choi, former assistant professor of neurology at the UT Medical School.
See Dr. Choi also at:
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Men who bike more than three hours a week should be aware that standard bicycle seats, ridden for extended periods, can cause temporary numbness and, in some, more serious problems, such as erectile dysfunction.
Such problems are caused by compression of an artery and a nerve connected to the penis. New seat designs to minimize compression are now available.
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