Signs And Symptons Of A Stroke And TIA

Stroke and TIA - Recognizing the warning signs and symptoms of a Stroke And TIA could someday save your life or the life of a loved one.  Not knowing these signs and symptoms could have been fatal to me a few years ago. To be forewarned is to be forearmed in the case of this life threatening event. 

Stroke and TIA are not same. A TIA is not a small stroke. The signs and symptoms of TIAs do not last as long as a stroke. The main difference, between a Stroke and TIA, is that a TIA is shorter in the duration of the symptoms and lacks permanent brain injury. Unlike small strokes, a TIA will not show changes on CT or MRI scans. The symptoms of TIA are the same as those of stroke, but they are only temporary and include the sudden onset of the following:

• Confusion or difficulty understanding speech or writing
• Eye pain
• Sudden, severe headache with no none cause
• Facial paralysis
• Falling and trouble walking (caused by weakness in the legs)
• Difficulty in swallowing
• Nausea or vomiting
• Gait changes, staggering
• Lack of coordination and clumsiness
• Loss of balance (Ataxia) and dizziness
• Sudden Numbness, tingling, changes in sensation
• Sensation that the person or the room is moving (vertigo)
• Speech Impairment (slurred speech or difficulty finding correct word))
• Drop attacks (falls suddenly without warning, with or without losing consciousness)
• Weakness of the arms or legs especially on one side of the body.
• Vision changes

• Loss of vision in one eye
• Decreased vision in one eye or both eyes
• Double vision

Two additional symptoms of a TIA are “Drop Attacks”. Drop attacks are when the affected person falls suddenly without warning. The second is Amaurosis Gugaxwhichis a specific type of TIA where there is a sudden loss of the vision in one eye. It occurs when debris from the carotid artery on the same side occludes or closes off one of the ophthalmic arteries and stops the blood supply to the retina.

Most symptoms occur suddenly, last only a short time (from a few minutes to 24 hours), and disappear completely. The danger is that they may occur again at a later time. Symptoms usually occur on the same side of the body if more than one body part is involved. Since it is impossible to tell if these symptoms are from a TIA or a stroke, the affected person should be transported to the hospital immediately.

TIAs are to be considered as a "warning sign" that a “stroke” may occur in the future, if something is not done to prevent it. Although, TIAs produce stroke-like symptoms they have no lasting damage. Most true strokes are not preceded by TIAs. However, more than one third of the affected persons who have suffered a TIA will have a reoccurrence of a TIA. Another one third of those affected persons will later have a stroke. TIAs are more important in predicting if a stroke will occur rather than when one will occur. TIAs can occur days, weeks or even months before a major stroke. In about 50% of the TIA cases, a stroke will occur within one year of the TIA.

The most common cause of a TIA is a clot (embolus) temporarily closing off or blocking an artery in the brain. This causes the blood supply to part of the brain to stop briefly. The temporary loss of blood flow to the brain can be caused by:

• Blood clot within an artery of the brain
• Blood clot that travels to the brain from somewhere else in the body (for example, the heart)
• Injury to blood vessels
• Narrowing of a blood vessel in the brain or leading to the brain

TIAs most frequently are caused from a dislodged build up of cholesterol and fatty material, in the walls of blood vessels (atherosclerotic plaque), in one of the major arteries in the head and neck (carotid arteries). TIAs can also occur from a blood clot that is formed within a blood vessel (thrombus) in the heart due to atrial fibrillation. TIA is related with several other major medical concerns such as hypertension, heart disease (especially atrial fibrillation), migraine headaches, cigarette smoking, hypercholesterolemia, and diabetes mellitus.

Atherosclerosis (hardening of the arteries) is a serious health condition where fatty deposits occur (close off) the inner lining of the arteries and dramatically increases the risk for both TIAs and stroke. Recent studies have shown that approximately 80% to 90% of the people who have suffered a stroke due to atherosclerosis have had a TIA episode previously.  Other risks factors of a TIA include high blood pressure, heart disease, migraines, smoking, diabetes, and increasing age.  About a third of those diagnosed with TIA will later have a stroke. TIAs are more common among men and black people.  There are generally no long-term effects of the TIA itself.  However, studies have shown that individuals who suffered a TIA have a 50% increased probably of having a stroke within the 3 months of the TIA.  20% of these strokes are fatal, and 67% are permanently disabling.

The symptoms and signs of the TIA may have disappeared by the time the affected individual arrives at the hospital.  Therefore, the affected person’s medical history may be the basis of confirming a TIA diagnosis.  Upon arriving at the hospital, a physical examination should be performed.  This exam should include a neurological exam and a take a blood pressure reading.  The doctor, using a stethoscope, should listen to affected person’s heart and arteries.  A bruit, which is an abnormal sound, caused by irregular blood flow may be heard when listening to the carotid artery in the neck or other artery.  Several tests that can be performed to rule out a stroke or other disorders that may have caused the TIA symptoms may include:

•  Head CT scan or cranial MRI
•  Blood clotting tests, including PT, to rule out a blood disorder
•  Carotid duplex (ultrasound)
•  Echocardiogram
•  Cerebral arteriogram
•  Complete blood count (CBC)

Some additional tests and procedures may be performed by the doctor to check for high blood pressure, heart disease, diabetes, high cholesterol, and peripheral vascular disease.  These tests include:

•  ECG
•  Serum lipids
•  Blood glucose
•  Blood chemistry
•  Chest x-ray
•  Tests for syphilis
•  ESR (Sedimentation rate) 

Although, we have no control over our genetic disposition for heart disease, stroke and TIA, we can work to eliminate or control some of the risk factors.  Managing risk factors such as smoking, diabetes, high blood pressure, and high cholesterol are critically important.

Treatment following a TIA should be for the purpose of diagnosing and treating its underlying cause. It is not always immediately possible to tell the difference between a Stroke and TIA.  Many times the affected persons, who are diagnosed as having suffered a TIA in a hospital emergency room, will be discharged and advised to contact their primary physician for further tests.

The use of anti-coagulant medications, heparin, and warfarin or anti-platelet medications such as aspirin are commonplace.  Aspirin is generally used to prevent future Stroke and TIA because it makes platelets less sticky and prevents clot formation.  If the affected person is already taking aspirin at the time of the TIA, alternative anti-platelet drugs such as clopidogrel sulfate (Plavix) or aspirin-dipyridamole ER (Aggrenox) may be used.  If the carotid ultrasound shows major narrowing of the artery (stenosis), a referral to a vascular surgeon may be necessary to unclog the artery with a carotid endarterectomy. 

Stroke and TIA are medical emergencies.  Do not ignore them!  If symptoms a TIA or stroke is suspected, call 911 or another local emergency number immediately. 

There is no way of knowing whether the symptoms will resolve, therefore, prompt medical or surgical attention is critical to prevent a fatal or disabling stroke event.  Depending on the local hospital’s capabilities, there may be only a few hours from the onset of symptoms to potentially use TPA (a clot-busting drug) to restore blood supply to the brain and reverse the neurologic deficits.

During this period of time, the affected person will need to be examined, blood tests need to be drawn, and a CT scan of the head will need to be performed to insure that a hemorrhagic stroke has not occurred.  Lastly a neurologist must be contacted.