TIA (mini-stroke) Symptoms, Diagnosis and Treatment

“TIA” stands for transient ischemic attack. Also known as a “mini-stroke,” a TIA signals an interruption of blood flow to a part of the brain. The underlying mechanism is the same for a TIA and an ischemic stroke. A blood clot blocks blood flow in an artery that supplies the brain. Symptoms can include vision problems, trouble speaking, sudden weakness, numbness or headache.

In a TIA, the blood clot breaks up on its own, usually over a few minutes. The blockage resolves and so do symptoms. The symptoms can last up to 24 hours.

In a stroke, the blood clot remains long enough to cause permanent brain damage and disability.

While there is no permanent brain damage from a TIA, consider it a warning of an impending stroke. About one third of people who have a TIA go on to have a stroke within a year.

What are the signs of a TIA?

The signs of a TIA are the same as stroke. You can’t tell the difference between a TIA and a stroke. Nor can you tell if a blood clot is temporary or more serious. It’s critical to note the time symptoms began and call 9-1-1 right away if you have:

Sudden weakness or numbness of the face, arm or leg

Sudden trouble seeing in one or both eyes

Sudden confusion, difficulty speaking or trouble understanding speech

Sudden severe headache with no known cause

Sudden dizziness or unsteadiness

Sudden loss of balance or trouble with walking or coordination

Loss of consciousness

Seizure in a person who does not have epilepsy

How is a TIA treated?

In a TIA, the blood clot dissolves on its own, but there is no way of knowing if this will happen. That is why it is important to call 9-1-1 right away at the first sign of any symptoms.

Once you have been diagnosed with a TIA, the goal of further treatment is to prevent a stroke. Your doctor will look for possible risk factors for stroke, such as high cholesterol, high blood pressure or atrial fibrillation. (Atrial fibrillation is an irregular heart rhythm that can raise the risk for blood clots and stroke.) Treatment of these risk factors is an important step to prevent stroke.

Medications

To prevent stroke, your doctor may start you on medications to:

Lower cholesterol

Control blood pressure

Prevent blood clots (such as aspirin or anticoagulants)

Surgery or angioplasty

There are two major arteries (called carotid arteries) in your neck that supply the brain with blood flow. If one or both of these arteries have significant plaque buildup (made of cholesterol and other substances), blood flow to the brain may be reduced. This puts you at high risk of a blood clot forming there or traveling from the heart and getting stuck there.

Angioplasty and stent placement may be advised to open up the carotid artery and help prevent stroke. Surgery to remove the plaque may be needed. This surgery is called carotid endarterectomy.

Finally, a large part of preventing stroke is adopting healthy lifestyle habits:

Follow a heart-healthy (low-fat and cholesterol) diet.

If you smoke, quit

Exercise every day or on most days of the week

Reach and maintain a healthy weight through diet and exercise

Always check with your doctor before you start or increase your exercise.

Angioplasty

What is angioplasty?

Angioplasty is also called percutaneous transluminal coronary angioplasty (PTCA), coronary artery balloon dilation or balloon angioplasty. Angioplasty increases the flow of blood and oxygen through a clogged heart artery without surgery. A physician uses an instrument called a catheter equipped with a tiny balloon to widen the opening in a partially blocked artery.

Why would I need angioplasty?

Angioplasty may be used when blood flow in one or more of your coronary arteries is restricted because of the gradual accumulation of cholesterol and fibrous tissue within plaques inside the arteries. The thickening of the inside walls of your arteries, called atherosclerosis, can lead to chest pain and a heart attack.

Angioplasty is an alternative to coronary artery bypass, which requires open-heart surgery. Angioplasty can also be used to open blocked arteries in your brain, neck, kidney, hip, abdomen, thigh and knee.

How do I prepare for angioplasty?

Your doctor may have you take aspirin or other anti-clogging medication before the procedure to reduce the risk of blood clots. You’ll also be told not to eat or drink after midnight before the procedure. Check with your doctor to see if you should take your routine medications on the day of the procedure. An EKG (electrocardiogram), chest x-ray and blood tests are done before this procedure.

How is angioplasty performed?

The procedure is usually done in a hospital. An intravenous line is inserted in your arm before the procedure. You are awake but given a sedative, and your heart and vital signs are continuously monitored with special equipment attached to you beforehand.

After you receive a local numbing medication, a catheter is inserted into the femoral artery in your groin or, in some instances, in the brachial artery at the inside region of your elbow. The catheter is threaded through your blood vessels. Once the catheter is positioned, a contrast dye is injected, allowing the physician to get pictures of the inside of your arteries. The exact areas and amount of blockage can be determined. This is called an arteriogram (or angiogram) and serves as a road map for the physician when reducing the blockage.

The physician then inflates a tiny balloon (balloon angioplasty) to compress the plaque against the arterial walls. More and more physicians are choosing to insert a small wire mesh tube (a stent) into the artery after angioplasty, to help keep it open over the long term. Another technique, laser angioplasty, employs a laser that emits pulsating beams of light to vaporize the plaque.

Once the procedure is completed, the catheter is removed and pressure is applied to the groin for 15 to 20 minutes. You are observed in a recovery room for an additional 30 to 60 minutes.

What are the risks and complications?

You may feel some pressure and discomfort during the procedure. In about 20 percent of patients, the artery narrows again within six months and angioplasty may have to be repeated. Serious complications, such as a heart attack, sudden cardiac death or emergency bypass surgery are rare.

However, if the treated artery becomes blocked again shortly after the procedure (a condition called abrupt vessel closure), you may need emergency bypass surgery.

What can I expect after the procedure?

You’ll likely feel groggy from the sedative, and may have bruising and soreness at the site of insertion. Medical personnel continue monitoring your vital signs, and you lie still with your legs straight for six to eight hours. You are given fluids and food after returning to your room. Notify the nurse or doctor immediately if you develop any chest discomfort.

You’ll likely be discharged from the medical facility after 24 hours, and be scheduled for a follow-up visit with your cardiologist.

Typical post-procedure instructions include no lifting of heavy objects, strenuous exercise or sexual activity for several days, caring for the catheter incision, and taking medication. Most people can return to work and normal activities in one or two days. Contact your doctor if you have bleeding or pain at the site of the insertion.

What are the alternatives to angioplasty?

The decision on how to best treat clogged coronary arteries depends on many factors. A patient’s age, underlying medical problems, and area and extent of blockage are considered before a treatment plan is developed. In general, angioplasty is less risky than the more invasive coronary bypass surgery, and it is often attempted first when the areas of plaque can be reached with a balloon catheter.

Easy and Versatile Summer Salad

In an attempt to prolong summer, I am adding this post to my blog, which I have actually had sitting on my computer for weeks.  Who knew blogging was a full-time job??  And since I have two full-time jobs already…one that pays me a salary and one that involves making sure my offspring become functioning members of society…the unpaid blogging gig got thrown to the back burner for a little while (much to my disappointment).  Anyone want to pay me to blog?

Anyway, when I woke up this morning and abruptly realized it’s September 1st already, and that means summer is all but over, I knew I needed to get this post up quickly, or I’d have to wait a whole year to post it.  So, here it is:

I was visiting a friend of mine out on the eastern end of Long Island a few weekends ago and, as it approached lunchtime, she suggested we make a salad.  So, I opened her refrigerator and immediately went for the mixed greens.  After all, isn’t lettuce the base of any salad?  But, my friend stopped me in my tracks and suggested we skip the lettuce and make more of a “Mediterranean-style salad”.  And that is the simple story of how my love affair with the “lettuce-less” salad came to be.  I have since made this concoction two weeks in a row and have made enough of the mixture each week to provide me with at least three meals (this week it was two lunches and one dinner).  It’s super simple, only involves a few ingredients, and can be paired with a wide variety of proteins and carbs to make it filling.  Read below for details.  Happy Summer! (Can’t I pretend?)

Salad Base:

–     2 fresh cucumbers, chopped into small (approximately ¼- ½ inch) cubes

–     2 or 3 fresh (vine, heirloom, or beefsteak) tomatoes – don’t get the cheap mealy tomatoes   -chopped into small (approximately ¼- ½ inch) cubes

–     ½ red onion – chopped small

–     A healthy snipping (to taste – the more the better) of FRESH dill

–     A drizzle of Extra Virgin Olive Oil

–     A sprinkling of Sea Salt

Here are some options for how to use this delicious base:

1 – Greek salad:

–     Add fresh pitted kalamata olives

–     Add reduced-fat (not fat-free – too high in sodium and other additives) feta cheese

–     Grilled chicken breast (optional)

2 – Greek salad wrap:

–     Add fresh pitted kalamata olives (4-5)

–     Add reduced-fatfeta cheese

–     Wrap in a whole wheat wrap

3 – Greek Yogurt Dish:

–     Combined the salad base with fat-free (or low fat) plainGreek yogurt

–     Added some additional fresh snipped dill

–     Eat with a whole wheat pita or an Arnolds 100% whole wheat sandwich round (optional)

(This was so refreshing – a great summer dish!)

4 – Tuna salad dish:

–     Make tuna salad, using low-fat mayo or vinegar

–     Added the cucumber/tomato salad base to a bowl and then mix in the tuna salad

–     (Optional) Eat it with a whole wheat pita, sandwich thin, slice of bread, or wrap

–     This was so refreshing – the dill complemented the tuna very well!

NOTES:

  • The salad tends to become watery after a day or so – just drain the liquid and it should be fine.

  • Before making these easy and healthy dishes, I would have told you that I wasn’t a huge fan of dill (it reminds me of my Jewish grandmother’s chicken soup…which does not exactly scream “light and refreshing summer dish”).  But, I am now a dill convert!  The dill was definitely the ingredient that stepped this mixture up from boring cucumber and tomato dish to delicious restaurant-quality dish!  I am very happy to add this to my arsenal – it’s a nice break from a lettuce based salad.  Hope you enjoy it as much as I do!