Stroke-like symptoms that come on suddenly and resolve quickly should never be ignored or dismissed as an insignificant, passing event. This type of episode, though temporary, could actually be a mini-stroke, or transient ischemic attack (TIA)—a warning sign that a potentially deadly or debilitating larger stroke may be looming on the horizon.
According to Gregory Kasper, MD, FACS, president and chief medical officer of Jobst Vascular Institute at ProMedica Toledo Hospital, a TIA can cause a variety of stroke-like symptoms, such as numbness or weakness in the face, arm, or leg, often occurring on one side of the body; trouble seeing in one or both eyes; trouble walking, dizziness, or loss of balance or coordination; confusion; or difficulty with speaking. This last symptom might involve slurring of words or expressive aphasia, meaning the person knows what he or she wants to say but simply can’t say it. The symptoms persist less than 24 hours—usually less than an hour—and then resolve completely.
Unfortunately, this relatively rapid resolution of symptoms can create a false sense of security in those who experience a mini-stroke. “After a TIA, many patients think, ‘Well, I don’t know what that was, but I’m back to normal now,’ and then they forget all about it. But if you have a TIA, it’s critical to see a doctor to begin a workup because the next episode may be something major. In fact, it’s estimated that 30 to 50 percent of patients who have TIAs and don’t seek treatment will have a stroke within a year,” says Dr. Kasper.
What causes mini-strokes? As Dr. Kasper explains, the leading theory is that a clump of platelets or a piece of clot travels “upstream” and blocks a small vessel in the brain, causing loss of function in that portion of the brain. Then, pressure builds up behind the blockage and it suddenly breaks up and disperses like a clump of sand, allowing blood flow and function to return. Enzymes produced by the body that dissolve clots naturally may play a role in releasing the blockage as well.
Because TIAs are temporary by nature and doctors are unable to perform tests to determine whether one has happened or not, diagnosis is based on pieces of information the patient provides, primarily his or her clinical history. Once it’s been established that a TIA likely occurred, potential causative factors can be explored.
Treatment for patients who have had a TIA or stroke has evolved significantly in recent years with the onset of neurointerventional surgery. Neurointerventionalists are highly specialized vascular surgeons who use advanced, minimally invasive techniques and devices to reach into blood vessels in the brain and clear blockages. “I equate plaques in blood vessels with potholes in streets. What collects in the bottom of potholes? Debris. Using specialized catheters and devices, we can go in there and clean out that debris. In the past, this was impossible because the vessels in the brain are tissue-paper thin. That’s what makes these new techniques so remarkable. However, we must get to the patient within a matter of hours to be successful,” Dr. Kasper says.
With respect to prevention, the same healthy lifestyle choices that help prevent stroke and heart disease can help keep TIAs at bay. Dr. Kasper advises patients—especially those with a family history of stroke—to keep their blood pressure in a healthy range, control their blood sugar level if they’re diabetic, eat healthy foods, exercise regularly, and avoid smoking. “Smoking is the biggest issue on the vascular side because it not only causes blood vessels to constrict, but also leads to hardening of the arteries,” he says. Moreover, your doctor may prescribe a daily aspirin regimen if you are at elevated risk of having a stroke.
As a potential sign of something more sinister, the experience of a TIA should prompt the victim to get medical attention. If you notice any of the stroke-like symptoms described above in you or someone else, don’t hesitate to seek treatment, even if they resolve rapidly and everything appears to be “back to normal.”
Remember, taking swift action in the event of a TIA could very well prevent a deadly or debilitating stroke in the future.❦