What you can do right away — and later — to prevent a full-blown stroke
The letters TIA stand for transient ischemic attack, otherwise known as a ministroke — but some health experts say that they also should stand for take immediate action.
The reason: Although a TIA typically lasts only minutes and leaves no permanent symptoms of brain damage, it often is followed by a full-blown stroke. Among US adults, stroke is the number-three cause of death and number-one cause of long-term disability. More than one-third of TIA patients go on to have a stroke — 5% of them within 48 hours of the TIA… 11% within 90 days… and 15% within one year.
The good news: A recent British study suggests that prompt treatment of a TIA reduces future stroke risk by 80%. So in a way, having a TIA is fortunate. Most people do not receive such a clear call to action — but those who do are likely to live stroke-free, provided they heed its warning. Here’s how…
KNOW THE WARNING SIGNS
By definition, a TIA lasts less than 24 hours, though the average duration is just a few minutes… and it causes no noticeable permanent neurological damage (though slight anomalies may be detectable with imaging tests). The cause of a TIA is the same as for most strokes — a blood clot that blocks blood flow to part of the brain.
The big difference: With a TIA, the clot soon disperses and symptoms disappear… with a stroke, the clot remains and damages the brain, sometimes fatally.
Symptoms of TIA and stroke are identical. Watch for sudden onset of…
- Numbness or weakness of the face, arm and/or leg, especially on one side
- Trouble speaking or understanding speech
- Vision problems
- Balance or walking problems
- Altered mental status (confusion, disorientation, loss of consciousness).
New finding: This symptom is far more common in women than men and often is not recognized as stroke-related.
TAKE IMMEDIATE ACTION
If you have any TIA or stroke symptoms, call 911. If diagnosed with a stroke, you may be given tissue plasminogen activator (tPA). This drug minimizes permanent disabilities — but only if given within three to four-and-a-half hours of a stroke. Every minute of delay diminishes that window of opportunity.
Even if symptoms abate on your way to the hospital or while you wait to be seen in the ER, you need to be evaluated by a doctor. Do not go home just because you feel better! In addition to a physical exam, blood tests and an electrocardiogram, you may be given imaging tests, such as a CT scan, MRI and/or ultrasound to rule out a real stroke or other cause of symptoms, such as a tumor. Typically, patients remain in the hospital for 24-hour observation after a TIA.
After being discharged, see your primary care doctor within a few days to discuss stroke prevention. If necessary, your doctor will refer you to a cardiologist or a neurologist.
MAKE A LONG-TERM PLAN
After a TIA, the goal is to guard against stroke by preventing blood clots, improving blood flow to the brain and promoting cardiovascular health overall. Treatment options…
Medication. Antiplatelet drugs keep blood platelets from sticking together and forming clots. These include clopidogrel (Plavix)…or a combination pill (Aggrenox) that includes aspirin and dipyridamole. Most TIA patients stay on medication for the rest of their lives.
Dietary changes. Make fruits, vegetables and whole grains the basis of your diet. Eat fatty fish (herring, salmon) twice a week. Avoid trans fats (shortening, partially hydrogenated vegetable oil), and cut back on saturated fats (meat, nonskim dairy foods). Have no more than one alcoholic drink daily. If you are overweight, reduce calories.
Exercise. Do moderate-intensity exercise for at least 20 minutes five days a week to promote blood vessel health and weight control.
Smoking cessation. Cigarettes increase blood clotting. Ask your doctor for a referral to a smoking-cessation program… and discuss ways to reduce cigarette cravings, such as using nicotine replacement therapy or the prescription drug varenicline (Chantix).
Hormone therapy (HT) reevaluation. Studies suggest that HT (typically taken to relieve menopausal symptoms) can increase stroke risk. Ask your doctor if HT’s risks outweigh its benefits for you.
Surgery. You may need an endarterectomy, in which a surgeon makes an incision in an artery and removes the plaque clogging it. A stent (mesh tube) may be placed in the artery to keep it open.
REDUCE RISK FACTORS
To minimize stroke risk after a TIA, it is essential to control…
Cholesterol. High cholesterol contributes to plaque and clot formation. If your blood level of LDL “bad” cholesterol is above 70 to 100 milligrams per deciliter, you may be prescribed a cholesterol-lowering statin drug, such as atorvastatin (Lipitor). Studies suggest that, after a TIA, statins are helpful even for patients whose cholesterol levels would otherwise be deemed “normal.”
Hypertension (high blood pressure). This more than quadruples stroke risk by weakening arteries. Blood pressure above 140/90 is a concern. If the lifestyle changes above plus stress-reduction strategies (such as daily relaxation techniques) do not lower blood pressure sufficiently, you may need medication to reduce blood volume, dilate blood vessels and/or halt chemical reactions that raise blood pressure.
Diabetes. This more than doubles stroke risk because high blood sugar levels increase arterial plaque. After a TIA, be especially vigilant about controlling diabetes through diet, exercise, weight loss and medication if necessary.
Atrial fibrillation (AF). An irregular heartbeat involving the heart’s upper chambers, AF prevents blood from circulating properly.
Treatment: Patients typically take a blood thinner, such as warfarin (Coumadin), to reduce clot risk. Heart rhythm may be reset to normal with medication or a nonsurgical procedure called electrical cardioversion, in which paddles placed on your chest deliver a shock to the heart. For some patients, heart rate is controlled with drugs or atrioventricular node ablation, in which radio waves are delivered via catheter to the pathway connecting the heart’s upper and lower chambers.