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| Different Strokes
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| The mini-stroke is different from its big bad counterpart—a major stroke can cause permanent damage or death. By heeding nature’s danger signs in the form of transcient ischemic attack or TIA, you may just help avert a catastrophic event.
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Call it a form of benign neglect, recklessness or wishful thinking, but human beings sometimes seem programmed to ignore signs of danger, particularly when it applies to matters of personal health.
As we all know, it’s not nice to fool around with Mother Nature.
Evidence suggests that nature often alerts us to impending stroke—sending compelling warning in the form
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of the mini-stroke or transient ischemic attack (TIA).
“Early risks of stroke after either a TIA or a minor stroke are eight per cent to 12 per cent at seven days and 11 per cent to 15 per cent at one month. This comes from recent evidence from the Oxford Vascular Study reported in the BMJ in January 2004,” says Dr. Amanda Thrift, head of epidemiology, National Stroke Research Institute, Heidelberg Repatriation Hospital in Victoria, Australia, (www.nsri.org.au).
The results of another British study published in March 2005 focused on 500 stroke victims and found that 43 per cent had experienced a TIA within a week of their stroke.
A mini-stroke, which may only last for minutes, is caused by a blood clot temporarily blocking an artery in the brain.
“The definition of a TIA is that the symptoms resolve within 24 hours. Therefore there are no residual symptoms in people experiencing a TIA. If patients’ symptoms persist beyond 24 hours, this is then considered to be a small stroke. People are often reassured when the symptoms resolve, however, this is a warning that there is some existing pathology that increases the likelihood of having a stroke. Perhaps one way of explaining it is that there is a continuum of pathological damage from TIA to small stroke to major stroke. Usually the larger the area of damage to the brain the more extensive the symptoms, and this results in a greater likelihood that the symptoms will persist,” Dr. Thrift explains.
Both TIA and major strokes share similar risk factors, including high blood pressure, smoking, advanced age, diabetes, irregular heartbeat and high cholesterol.
Some people may experience a TIA and not know it.
“They may put the symptom down to some other cause, for example, numbness may be thought to be due to a pinched nerve. In addition, they may not recognize that they have a neurological deficit, whereas witnesses may recognize it,” says Dr. Thrift.
There is reason to think that TIAs can occur without manifesting symptomatically.
“This evidence comes from imaging (CT etc.) whereby a patient may have evidence of damage on CT of the brain but they report that they have never had any symptoms. It is unclear whether these people may have had the TIA when they were asleep (and the symptoms resolved by the time they awoke), or whether the damage was so small that no symptoms resulted. Most likely both scenarios occur,” reports Dr. Thrift.
Fewer (TIA) symptoms or the absence of symptoms are evidence of less severe pathology, according to Dr. Thrift.
“An observational study found that a longer duration of symptoms—more than 10 minutes—and symptoms consisting of weakness or speech impairment were associated with subsequent stroke within 90 days following the initial TIA,” adds Dr. Amie Hsia, clinician at the National Institutes of Health/National Institute of Neurological Disorders and Stroke, Section on Stroke Diagnostics & Therapeutics in Betheseda, Maryland.
He cautions: “An important message is that if someone experiences neurologic symptoms suggestive of stroke or TIA …he/she should seek emergency medical care rather than wait to see if the symptoms resolve because certain treatments can only be administered within a limited time window after the onset of symptoms.”
TIA Symptoms:
- Numbness or weakness in your face, arm, or leg, particularly on one side of the body.
- Difficulty moving your fingers, hand, arm, or leg.
- Impaired vision in one or both eyes, or difficulty hearing with one or both ears.
- Unable to speak properly or comprehend what others are saying.
- Trouble walking, or loss of balance or coordination.
- Dizziness. Sudden severe headache without apparent cause.
“Seek medical attention as soon as possible. Diagnosis of a TIA is more likely when presenting quickly. This is because either the symptoms are still present or the patient can recall the details of the event more accurately. In addition, preventive measures can be introduced to reduce the likelihood of having a further event or a more major one,” advises Dr. Thrift.
Long-term measures that may help lower the risk of mini-strokes and stroke include losing weight if necessary, undertaking regular physical exercise, improving dietary habits and cessation of smoking.
Short-term treatments exist to help prevent stroke among those at high risk—especially those who have experienced a TIA.
“TIAs and strokes are due to a variety of mechanisms and therefore there are different potential interventions depending on the mechanism involved. For example, a TIA could be due to plaque rupture from the carotid artery in which case urgent surgical removal of this plaque will be highly effective in preventing subsequent stroke,” says Dr. Hsia.
“In other cases, a TIA is the opportunity to assess a patient’s stroke risk factors, optimize their medications for reducing their risk of subsequent stroke, and encourage behavioral modifications such as smoking cessation.”
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