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Harvard Heart Letter | February 2008
Mini strokes are a maxi problem
Treat a transient ischemic attack with the same urgency as chest pain.
Transient
ischemic attacks (TIAs), sometimes called mini strokes, were once
written off as fleeting problems that posed little danger once they had
passed. No longer — these brief strokes are now seen as harbingers of
trouble ahead. A study shows that a TIA often heralds a full-blown
stroke, and that treating it as an emergency can help stave off the
real thing.
A TIA occurs when part of the brain is suddenly
deprived of oxygen. The symptoms depend on what part of the brain is
affected (see “TIA symptoms”). It starts when a blood clot or bit of
cholesterol-clogged plaque lodges in an artery nourishing the brain.
The blockage is small enough or fragile enough that the body’s
self-repair systems can clear the artery, usually within an hour,
although sometimes it takes up to a day. Larger, more durable blockages
cause a stroke, which is characterized by long-lasting problems.
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TIA symptoms
If
you, or someone with you, suddenly experiences one or more of these
symptoms, call 911 or your local emergency medical services number —
even if the symptoms start to fade away.
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Numbness or weakness in the face, arm, or leg, especially on one side of the body
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Inability to move the fingers, hand, arm, or leg
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Confusion
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Slurred speech or other trouble speaking
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Difficulty understanding what someone is saying
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Trouble seeing with one or both eyes or hearing with one or both ears
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Dizziness, trouble walking, or loss of balance or coordination
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Rapid and severe headache
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Temporary doesn’t mean harmless
New
brain-scanning technology shows that some TIAs cause lasting brain
damage. They can also presage an even more disastrous injury.
Oxford
University researchers analyzed 18 studies that included more than
10,000 people who had a TIA. Overall, one in 20 went on to have a
full-blown stroke within a week; one in 10 within three months. When
the researchers looked at individual studies, the range of results was
revealing. Among people treated quickly in specialized stroke centers,
under 1% had a stroke during the week following the TIA. Among those
who didn’t seek urgent treatment, 11% had a stroke the following week.
The report was published in the December 2007 issue of Lancet Neurology.
This
work highlights the dangers of brushing off a TIA as just a scary
nuisance. Treating it as an emergency, just as you would treat chest
pain, may nip a TIA in the bud, minimize permanent brain damage, and
help prevent the long-lasting disability of a stroke.
If
the TIA is still under way when you get to the emergency room, you
might be given aspirin, Plavix, or another medication to help break
apart the blockage. If the symptoms have passed, that’s okay — most
treatment focuses on what might be ahead, not on what just happened.
And the sooner you get started, the better.
The National
Stroke Association recommends evaluation by a stroke specialist. He or
she may order a scan of your brain and carotid arteries, the main
arteries that deliver blood to the brain. Identifying what caused the
TIA is important for planning the strongest defense against another
one, or a stroke.
Each year, more than a quarter-million Americans have a TIA. If you are among them, don’t waste a minute getting help.
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