Posts Tagged TIA
“Silent Strokes” Different than TIAs, Experts Say
If you are an older American with no major health problems, chances are about one in 10 that you have had a stroke and did not know it, according to a report in the medical journal Stroke.
It was probably not severe enough to cause recognizable symptoms, such as vision problems, facial weakness, or trouble walking, but it was still a blockage of a brain artery, and it reduced your thinking powers just a bit.
That estimate comes from a new study of 2,040 people, average age 62, in the long-running Framingham Offspring Study.
Magnetic resonance imaging (MRI) scans showed that 10.7 percent of them had experienced what study author Dr. Sudha Seshadri, at Boston University, calls “a silent brain infarct.”
It is the cerebral equivalent of what physicians call a myocardial infarct – blockage of a blood vessel that causes damage to heart tissue. In the case of a silent stroke, the blockage and the damage occurs in the brain, without symptoms.
TIA Has Symptoms, Silent Stroke May Not
A silent stroke is different from a transient ischemic attack (TIA), a momentary loss of brain function, says Dr. Seshadri. A TIA causes some symptoms, while a silent stroke, by definition, does not.
But both are warning signs to pay attention to the well-known risk factors for stroke, such as cholesterol levels, blood pressure, obesity, and smoking.
The incidence found in the Framingham Offspring study “was within the ballpark of what prior studies have suggested,” notes Dr. Seshadri.
“But this was a group of people who were younger than in most of the prior studies,” she says. “The fact that one in 10 persons had silent attacks that had subtle side effects on the brain is something we should be concerned about and should address.”
The effects of a silent brain infarct show up on an MRI scan as “small lesions in various parts of the brain,” says Dr. Seshadri. “We can’t tell from that whether they had a symptomatic attack.”
And the MRI scans give no clues as to when the silent stroke occurred.
Testing showed that “on average, compared to age-matched controls, those with lesions do have subtle signs, such as loss of flexibility of talk,” she says.
Address Risks Through Lifestyle Changes
The incidence seen in the study did not startle Dr. Claudette Brooks, at West Virginia University Health Sciences Center.
“When I look for the cause of headaches and similar problems, it doesn’t surprise me when I see these lesions, and other colleagues tell me they see them,” says Dr. Brooks.
An even higher rate of silent strokes might be expected in a study of African Americans, she notes.
“They have a higher incidence of hypertension [high blood pressure], atherosclerosis, and hyperlipidemia [excess blood fat],” says Dr. Brooks.
Nothing special needs to be done to reduce the risk of silent stroke, both physicians say.
“I wouldn’t recommend that people rush out to have an MRI,” says Dr. Seshadri. “It’s up to the medical and public health community to emphasize the importance of controlling risk factors.”
“The whole thing boils down to modifying risk factors,” explains Dr. Brooks. “If you don’t have risk factors such as high cholesterol, obesity, and diabetes, try to keep yourself out of the group that does. If you do, modify them by keeping blood pressure and cholesterol down, things like that.”
Always consult your physician for more information.
Online Resources
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National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Neurological Disorders and Stroke
Stroke – Prevalence and Correlates of Silent Cerebral Infarcts in the Framingham Offspring Study
Add comment September 9, 2008
Take a Mini-Stroke Seriously, Seek Medical Attention
Physicians call them transient ischemic attacks, but they are more commonly known as “mini-strokes.” But make no mistake – they can be deadly.
What is worse, many people who suffer such an attack rarely seek medical help.
Just one in 10 people who experienced symptoms of a transient ischemic attack (TIA) sought the proper emergency care, says a recent study published in the journal Stroke.
Urgent care is critical, because some people who suffer TIAs will have a major stroke as soon as a day or two after the mini-stroke.
“People need urgent medical attention not for the symptoms that have passed but for what might be coming,” says Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University Medical Center.
“Many people don’t have a TIA before they have a stroke, so, in a sense, it’s fortunate to have one. Now you have a chance to intervene,” he says.
Symptoms Similar to Major Stroke
A transient ischemic attack occurs when blood flow to a part of the brain is temporarily blocked. When this occurs, symptoms come on suddenly and last anywhere from a few minutes to many hours.
Symptoms may include:
- sudden loss of speech or the ability to understand others
- rapid onset of weakness or numbness of the face, arm or leg, especially if it occurs on only one side of the body
- sudden loss of, or change in, vision that may occur in one or both eyes
- sudden difficulty walking or maintaining balance
One thing you may not feel with a stroke is pain.
“Pain is not the right thing to look for in stroke,” says Dr. Christian Schumacher, a neurologist at the Stern Stroke Center at Montefiore Medical Center in New York City. “People expect that like a heart attack, which is often painful, that stroke will cause pain. But stroke symptoms are, in most cases, without pain.”
One exception, adds Dr. Siller, is what is known as a hemorrhagic stroke. In this instance, you would likely experience a sudden, severe, unexplained headache. If you have such a headache or any of the above symptoms, says Dr. Siller, you should get to the hospital immediately.
Unfortunately, not many people realize the need for urgent care. In the Stroke study, British researchers surveyed 241 people who had experienced a transient ischemic attack.
Just 44.4 percent sought medical care within a few hours of experiencing TIA symptoms, and only 10 percent sought any emergency medical care at all for their symptoms.
Another 44 percent waited longer than a day after their symptoms to seek care.
Persons with symptoms that lasted more than one hour, as well as those with motor symptoms such as difficulty walking, were more likely to seek care.
If the TIA symptoms occurred on a weekend, people were more likely to delay seeking treatment.
People “want to wait until they feel better, and most TIAs get better within an hour. If it gets better, people just think, ‘Oh, that was weird,’ and then they may call their doctor later,” says Dr. Schumacher.
Or, they may just forget the symptoms altogether, says Dr. Siller. “When symptoms are gone, and they feel better, people forget. But, it’s a misconception that if it went away, it doesn’t mean anything.”
Physicians Determine Severity
Dr. Schumacher notes, “Although TIA is called a mini-stroke; it’s like having a real stroke. It’s a warning sign for a major disabling stroke.”
Getting to the hospital as soon as possible after TIA or stroke symptoms begin is critical. The reason: Clot-busting drugs that can spare you many of stroke’s worst effects – including paralysis – have to be administered within several hours after the onset of symptoms to be effective, explains Dr. Siller.
“If you wait, we can’t do as much to help you,” he says.
Dr. Siller also recommends discussing your risk factors with your physician.
The most common risk factor for stroke is a past history of a stroke or a TIA. People with high blood pressure, high cholesterol, diabetes, and those with heart disease also have an increased risk of stroke, making it even more important for them to act quickly if they have any TIA symptoms.
Always consult your physician for more information.
Add comment February 7, 2008
