TIAs: Don't call them ministrokes

I've called them ministrokes before, but this article from U.S. News makes me re-think that phrase. It contends that you shouldn't call transient ischemic attacks ministrokes:

Yet, while 35 percent of adults in the U.S. have had symptoms suggestive of a TIA, only 3 percent of them called 911 for help, according to a recent online survey of more than 2,000 people by the American Heart Association and American Stroke Association. That’s a mistake, experts say. If you have symptoms of a stroke or TIA, “don't wait it out,” advises Dr. Dion F. Graybeal, medical director of stroke at the Baylor University Medical Center in Dallas. “Take these symptoms seriously and call 911.” If it’s a real stroke, every minute counts in terms of getting treatment and reducing the risk of permanent disability. And if it’s a TIA, “it’s an opportunity to intervene and hopefully stop a process or condition that could cause a stroke with disability in the future,” Graybeal says.

It’s better to be safe than sorry because if you have stroke-like symptoms, it’s difficult to tell immediately if you’re having a TIA or a full-blown stroke, says Dr. Nieca Goldberg, a cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center in New York City. So it’s important to get to the hospital as soon as possible, There, you will most likely have a CT scan, a CT angiogram, an MRI or an MR angiogram of your brain and the blood vessels in your head to look for a blood clot and evidence of damage to the brain. If damage isn’t apparent and the symptoms have resolved, the episode will be deemed a TIA. But if there is evidence of damage to areas of the brain, the event will be diagnosed as a stroke, even if the symptoms have gone away, Goldstein says.

Up to 1 out of 3 of you have had a stroke - perhaps without knowing

Have you ever had a stroke? Perhaps you had one but didn't recognize it. Read this link how 1 in 3 Americans may have had warning stroke without knowing it:

 ... [A]bout 35 percent of Americans experience symptoms of a warning stroke. Yet only about 3 percent get immediate medical attention.

Most adults who had at least one sign of a "mini" stroke - a temporary blockage also known as a transient ischemic attack (TIA) - waited or rested until symptoms had faded instead of calling 911 right away, according to the research from the American Heart Association/American Stroke Association (AHA/ASA).

"Ignoring any stroke sign could be a deadly mistake," said ASA chair Dr. Mitch Elkind, in a news release from the organization.

Myth No. 2: Just wait it out, and if you feel better, ignore it

Most of us have heard stories or actually witnessed it - someone is having stroke-like symptoms but instead of seeking immediate help, simply waits.

And sometimes, the symptoms go away and the person never seeks help.

But it's a myth that you shouldn't bother with help after a transient ischemic attack, or a mini-stroke. They can be precursors for something far, far worse.

Read this story, which I cited several before, on how one in eight strokes are preceded by a mini-stroke:

Aspirin and you - reasons to take that lowly pill

Take two aspirin and call me in the morning, the old joke goes.

Now, we're told, aspirin just after a mini-stroke (also known as a transient ischemic attack, or TIA). It might keep you out of trouble. Read about how an immediate aspirin after mini-stroke cuts risk of major stroke:

"A great many people who have (mini-strokes or TIAs) don’t seek medical attention, and don’t feel that it’s an emergency," said lead author Peter Rothwell of the Stroke Prevention Research Unit in the Nuffield Department of Clinical Neuroscience at John Radcliffe Hospital in Oxford in the U.K.

Call it "mini" but don't call it unimportant

Just because something is called "mini" doesn't mean it's not big.

A mini-stroke - or transient ischemic attack, TIA for short - is often a sign for a devastating stroke to follow. So take it seriously.

I posted a similar item last week, but it's worth repeating - quick, aggressive treatment for TIAs could slash major stroke risk by 50 percent:

According to the researchers, sending a person to the hospital after a “mini-stroke,” even if the muscle weakness or slurring of speech lasted a mere few seconds, could reduce the risk of major strokes by as much as 50 percent. TIAs, after all, are oftentimes a sign that a more serious, possibly fatal stroke may be coming in days, or even a few hours.

Mini-stroke can lead to a big problem - take it seriously

Take mini-strokes seriously - that's the bottom line of some interesting research. Read more how aggressive treatment of "mini-strokes" lowers risk for major stroke:

Better and faster use of secondary stroke prevention methods after transient ischemic attacks, or TIAs, helps reduce risk of additional strokes and death, according to researchers involved with an international study.

With the most aggressive care available, researchers at 21 sites around the world cut in half the risk of a second stroke among participants in the five-year study, which is published in the New England Journal of Medicine.

So don't just sit there - take action if you see the symptoms!

Post-TIA brain scans might yield vital information

Nobody likes to hear bad news - but sometimes, bad news might save a life.

Many people have transient ischemic attacks, or mini-strokes, before a larger stroke occurs. Now, imaging after a mini-stroke can help map a plan of treatment and, potentially, preventing a more serious stroke.

You can read here about how brain scans yield clues to future stroke risk:

Brain scans taken shortly after a mild stroke can help identify patients at risk of suffering another stroke within three months, a new study suggests.

Dr. Groucho got it right

Groucho Marx might have said it best: "I intend to live forever, or die trying."

I can connect with Groucho after a hole in my heart was closed back in 2007. Click on this link for info about my patent foramen ovale (PFO) closure and why.

The short story version is that the hole between the upper two chambers in my heart apparently allowed a blood clot to circumvent the clot-filtering mechanism in the lung, leading to a stroke in 1998 and a mini-stroke in 2007.

Since then, I've seen lots of studies indicating that this procedure might or might not be the best way to treat stroke survivors, looking at procedure vs. blood-thinning medication. My concern about warfarin (also known as Coumadin) was that as a fairly active person, taking pills that make you bleed easier might not be a good idea. Plus, pills and the related monthly blood tests cost money. I ditched the pills six months after the procedure.

That's more of a long-term concern instead of the relatively short-term outcomes in most studies. However, a recent study suggests that PFO closure may be cost-effective over long term:

PFO closure reached the incremental cost-effectiveness threshold of  < $50,000 per quality-adjusted life-year (QALY) gained in 2.6 years. Moreover, the treatment met the threshold of < $50,000 per life-year gained in 4.9 years. The per-patient mean cost of medical therapy surpassed that of PFO closure after 30.2 years of follow-up.

Now, I was in my 40s when my PFO closure occurred, so I plan to live 30.2 years (and more, I hope!) afterward.

Stress, depression may boost stroke risk

Don't ignore stress and depression - it's already serious, and it could become even more serious. Check out this recent study how stress and depression may boost stroke risk:

The study found that depression seemed to raise the risk of a stroke or a transient ischemic attack (TIA) by 86 percent. It also found that stress apparently raised stroke or TIA risk by 59 percent. And hostility doubled the risk, the researchers said. A TIA is a mini-stroke caused by a temporary blockage of blood flow to the brain.

However, it's important to note that the study only found an association between the risk of stroke and negative emotions. It wasn't designed to prove that negative emotions can cause strokes.

Still, "chronic stress and negative emotions are important psychological factors that affect one's health, and findings from this study link these factors to brain health in particular," said the study's lead author, Susan Everson-Rose, an associate professor of medicine at the University of Minnesota.

"Patients and their health care providers should be aware that experiences of chronic stress and negative emotional states can increase risk for stroke," she noted.

Don't just shrug off a mini-stroke

TIAs - or transient ischemic attacks - are too often shrugged off as unimportant. However, that's wrong.

Even if the person can move and speak with no difficulty after a mini-stroke, that doesn't mean the patient and professionals should walk away and do nothing. A recent study showed that many patients with TIA have long-term cognitive impairment:

"Our findings confirm what we experience in daily practice: While motor and language disturbances recover within 24 hours after a TIA, long-lasting cognitive complaints are a problem for many patients. There needs to be more clinical awareness of this issue," lead investigator Ewoud J van Dijk, MD, from the Radboud University Nijmegen Medical Centre, the Netherlands, told Medscape Medical News.

He suggested that a TIA affects complex networks that are involved in cognitive functioning. "These networks are likely more vulnerable than those involved in motor and language function. Further study is needed to confirm this, but physicians should be aware of these cognitive dysfunctions because it potentially affects quality of professional and daily living," he said.

Drug combo may reduce risk of second stroke

I was on aspirin and Plavix for several years to prevent a second stroke. I eventually had a mini-stroke (or a transient ischemic attack) anyway. Still, more info to discuss with your own doctor. Check out this article about how a study shows this drug combo may reduce risk of second stroke:

After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone. ...

"Giving two drugs that block platelets works a lot better than aspirin alone in people who have had a minor stroke or TIA," said researcher Dr. S. Claiborne Johnston, a professor of neurology at the University of California, San Francisco.

The trial was done in China, so whether the results would be the same in the United States isn't known. "They probably are, but we would like to see them confirmed," Johnston said.

A follow-up about holes in the heart

Almost five years ago - how time does fly - the hole between my two upper chambers were closed by a catheterization procedure.

Doctors had guessed since 1998 that my stroke at that time was caused by a series of actions:

• A hole in the heart we're all born with - patent foramen ovale - never closed.
• The wall between the two chambers was not a nice straight, smooth surface, but was more wavy with a divot, also called an atrial septal aneurysm.
• Normally, blood pumps into the vein side of the heart, then out the lungs to get oxygen and get filtered for clots and debris, the back into the arterial side and eventually out to the brain and body,
• However, clots and debris could collect in the divot and with a little extra chest pressure - even a sneeze - could push that from vein side to arterial side, bypassing the filtering process.
• The clot or debris is pumped out to the brain.
• Stroke happens.

So, after a transient ischemic attack, or a TIA mini-stroke, in 2007, I decided to take an offer to close that hole. (See video below.) It went great. A little over a year later, I finished a marathon.

Now, however, a new study stirred questions about whether the procedure works any better than medication. I was on a blood-thinner called warfarin, or Coumadin.

I think, though, one important takeaway from this research came from an ABC News quote:

Dr. Anthony Furlan, the study's lead author and chairman of neurology at University Hospitals Case Medical Center in Cleveland, said the evidence just isn't there to support a PFO closure procedure over simply giving patients medication.

"We're not saying there are no patients who should have the hole closed, but we are saying the selection criteria have to be radically refined," he said. Ideally, a patient would be under age 45, have a very large hole in their heart and a heart defect called an atrial septal aneurysm.

When my stroke occurred, I was a "young" 39. Plus, the atrial septal aneurysm was - now much more solid thanks to the device implanted - present.

Did I really want to be on a sometimes-dangerous blood thinner for the rest of my life? No. For me, I think the closure was the best choice. Is it  for everyone? The real answer, like many medical answers, is not so clear. Each individual's circumstances should be considered.

Important: Even mini-stroke prevention

A somber story from USA Today and reported elsewhere: 'Mini-strokes' can shorten life expectancy.

The study calculated life expectancy by comparing mortality rates among people who had TIAs with other people of the same age and sex. Life expectancy declined steadily each year. After nine years, almost half of the TIA patients had died — 20% more than in the general population, according to the study of 22,000 people published Thursday in Stroke: Journal of the American Heart Association.

While having a TIA didn't substantially increase the risk of death in people younger than age 50, the attacks did increase mortality for those older than age 65. About 5 million Americans have had a TIA, according to the heart association.

TIAs are "very bad harbingers," says Nehal Mehta of the University of Pennsylvania's School of Medicine, who wasn't involved in the new study. Up to 10% of TIA patients have a major stroke within 48 hours, the American Heart Association says.

This is not a scare tactic, but a reminder that stroke prevention is clearly important, especially those people older than 65.

Shuffling gait might be clue of mini-stroke history

We all see people shuffling rather than walking, often associated with older people. Now, a study showed how transient ischemic attacks - or TIAs, may cause the shuffling gait of old age:

The small strokes may impair their ability to walk, balance and function just the same.

Scientists examined the brains of 418 priests and nuns after they died. The researchers found that one-third of the brains that had seemed normal using conventional tests while the people were alive actually had damage to tiny blood vessels. The damage was so slight it was impossible to see without a microscope.

The people whose brains had these tiny signs of hardened arteries and stroke were most likely to have had shuffling gait and other movement problems while they were still alive.

What good is this info? Well, a mini-stroke is a warning that a bigger one is on the way. So an unexplained shuffling gait might mean the person should take precautions - watching blood pressure, for example, and seeing a doctor about this - to perhaps prevent a more devastating stroke.

One more reason to get help fast!

If you've visited this blog before, you've heard this line before: If you are having any stroke sign or symptom, even one, call 911 and get to an emergency department that is a stroke center quickly.

Even a mini-stroke - a transient ischemic attack, or TIA - can be a harbinger for a full-blow stroke. Now, we find that according to one study, 'mini strokes' are linked to doubled heart attack risk:

Although TIA symptoms may last only a few minutes, they are a warning of coronary heart disease that may be unrecognized, said Dr. Larry B. Goldstein, a professor of medicine and director of the Duke Stroke Center at Duke University Medical Center, who was not involved in the study.

The study confirms that "people who have had a TIA or stroke should also be evaluated for coronary heart disease," said Goldstein.

Live TV lesson about stroke signs

The chilling video of  Los Angeles TV reporter Serene Branson was played over and over the last few days. She began stumbling over slurred words on live television. Her face appeared not quite symmetric - class stroke signs.

Turns out, as U.S. News and World Report reported, her severe migraine mimicked a stroke:

Doctors at the University of California, Los Angeles, who performed a brain scan and blood work on Branson, said she suffered a type of migraine - often called a complex or complicated migraine - that can mimic symptoms of a stroke, the Associated Press reported Friday.

Dr. Ralph L. Sacco, president of the American Heart Association and chairman of neurology at the University of Miami Miller School of Medicine, explained that "a complicated migraine can often masquerade as a stroke or TIA (transient ischemic attack, sometimes called a mini-stroke)."

The symptoms can look just like a stroke, Sacco said, including loss of vision, blurry vision, paralysis on one side of the body, trouble speaking and trouble walking. "All kinds of things we associate with a TIA or stroke can be part of a complicated migraine," he said.

For people whose first experience with a migraine is a complex migraine, Sacco advises that they assume it is a stroke, however.

"If people have these classic symptoms, we should treat them as the emergency we think they are, which is a possible stroke," he said.

Branson did the right thing: Even though her symptoms subsided, she sought follow-up care. Too often, people don't see a doctor after a mini-stroke, setting themselves up for full-blown strokes. The lesson we can all take away: When you detect these signs, get help right away. It might just save a life.

From ABC News, a video of a good discussion of stroke signs:

Another take on stroke/TIA study

The other day, I posted a note how a transient ischemic attack should be considered a warning about a full-blown stroke.

But on the flip side, that same recent study showed that stroke strikes without warning in majority of patients. So while you should a TIA seriously, the study shows the incredibly importance of taking stroke signs seriously - they can come without warning.

So as always: be aware of stroke signs, and move quickly to get some help!

Take warnings signs seriously

It's too easy to ignore a mini-stroke or transient ischemic attack - TIA - instead of acting and taking the event seriously.

After all, you get over it, with no lingering effect, right?

Wrong. A recent story, based on recent research, reporting that one in eight strokes are preceded by a TIA:

Mini-strokes, or TIAs, have the same symptoms as a full blown stroke, including sudden weakness, slurred speech and difficulty walking. The symptoms last only minutes or hours and since people recover within a day, many don't take them seriously.

But doctors say patients who suffer mini-strokes should seek immediate medical treatment, because intensive treatment can prevent a larger stroke.

For the study, researchers looked at 16,400 patients who went to Ontario hospitals after having a stroke over four years. Among the patients, 2,032, or 12.4 per cent, reported having the symptoms of a TIA prior to a major stroke.

This is a case where common sense prevails. Take action on a TIA, and you could avoid a deadly or severely damaging stroke. So take that action if you think you or someone you care about is having a TIA. Make sure you know the signs.

Get to an emergency room - or better still, a local stroke center if available - as soon as possible. Best bet: Call 911.

Simple test for those with risk

A transient ischemic attack can be a sign for worse to come, and strokes can reoccur. So an interesting story: Ankle test tells heart risk after TIA, stroke:

[A] simple test of blood pressure at the ankle can detect asymptomatic PAD [peripheral arterial disease], giving patients a chance to reduce their risk.

Heart disease risk goes way up in people who have suffered strokes or TIAs. That risk is even greater in people who also have PAD, a sign that plaque is clogging the arteries.

Should everyone rush out and get their blood pressure checked at their ankles? No. However, as the article notes, "But it is advised for people at high risk of PAD." When in doubt, ask your doctor.

(Image from the National Heart, Lung, and Blood Institute)

TIA care in the right places does matter

They aren't strokes, exactly, but take a TIA seriously.

A transient ischemic attack "a brief episode of a given neurological abnormality that resolves on its own, and by definition, TIA sufferers recover completely within a few minutes (or a few hours, at the most)," according to the recent article stroke hospitals offer better care for TIA patients.

And not surprisingly, stroke hospitals (those with stroke units) appear to be better than [other] hospitals at doing this. This is probably due to the presence of stroke experts in their facilities, which guarantees that patients with TIAs undergo rapid and thorough testing. This was shown in a recent article in the Medical Journal of Australia.

So be sure you know the TIA symptoms and take them seriously. Don't let anyone you care about - hey, that should be everyone, right? - just shrug it off. TIAs can be signs of a even more serious events to come. If you can, get to a stroke center, as they are called in the U.S. You can find them here if you pick your ZIP Code, with a range of at least 25 miles, choose Type of Service and choose a Certified Program called Stroke (Primary Stroke Center).