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The Stroke Warning That Can Save Your Life

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Have you ever had a transient ischemic attack (TIA)?

Before you answer, consider this fact: A high proportion of Americans who have had symptoms consistent with a TIA don’t recognize the significance of the episode and do not seek urgent medical attention. 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 symptoms, even though it can result in permanent brain injury in up to one-third of patients.

Frightening statistic: Anyone who has had a TIA is at high risk to have a full-blown stroke over the next two days, has a 15% to 20% increased risk within three months.

Still, many people who have a TIA—or even suspect one—do not see a doctor. There is a potential additional problem: One study found that 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).

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.

Important: If you have TIA symptoms that last for more than a few minutes, call 911. Even if the symptoms completely resolve, you need to get to the closest emergency department as soon as possible and tell the personnel that you may be having a stroke.

GET 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 serious health problems, such as diabetes or a brain tumor, can trigger TIA-like symptoms. TIA-like symptoms can also be caused by migraine headaches. If you’ve had a TIA, the underlying problem, such as a blood clot, 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 (to assess the overall health of the heart) and a brain imaging study, such as a CT or a magnetic resonance imaging (MRI) scan.
  • Specific tests. Depending on your case, other tests, such as an ultrasound, magnetic resonance angiogram (MRA) or CT angiogram, may be used to determine if there is a blockage in one of the arteries that supply the brain. Also, a heart-monitoring test may be necessary to check for atrial fibrillation—a disturbance in the electrical rhythms of the heart that can generate stroke-causing blood clots. 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 healthful 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 (a DASH or Mediterranean-type diet)…exercise (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.

Other approaches…

  • Blood thinners. If tests show that you have atrial fibrillation, your doctor will probably prescribe a blood thinner, such as warfarin (Coumadin) or another anticoagulant. 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 when used as treatment for more than a short period, 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 five points diastolic (bottom number) can reduce risk for a post-TIA stroke by nearly 40%. Note: Normal blood pressure is less than 120/80 mmHg.
  • 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, or you may need to have a stent, a tube that helps keep the blood vessel open.

DO YOU KNOW WHEN TO CALL 911?

A transient ischemic attack (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 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.

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Source: Larry B. Goldstein, MD, chairman, department of neurology, University of Kentucky, codirector, Kentucky Neuroscience Institute. He has published more than 700 journal articles and other professional papers and three books for health professionals and serves on the editorial boards of Stroke, Neurology, Journal of Stroke and Cerebrovascular Disease, and Cerebrovascular Diseases. Date: February 8, 2018 Publication: Bottom Line Health
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