Temporary brain attack


  • Health
  • Sunday, 19 Oct 2003

Description 

THINK of a stroke, but one that usually lasts less than 10 minutes, and not longer than 24 hours. That’s a temporary brain attack, or what is commonly known as a transient ischaemic attack (TIA). It occurs when the supply of oxygen is temporarily cut off to an area of the brain. 

What happens during an attack

There are many things that can happen with a TIA. These depend on the area of the brain that is deprived of oxygen. Some of the symptoms include speech problems, clumsiness or weakness on one side of the body, loss of vision in one eye, double vision, visual problems affecting both eyes, a sensation of spinning (vertigo), inability to walk (ataxia), and even loss of consciousness or temporary amnesia. 

What causes TIA

Often, the term mini-stroke has been associated with an episode of TIA. This is not quite accurate because TIAs are temporary. They are, however, warning signals of a future stroke and are real emergencies. You can even compare a TIA and stroke to angina (heart pain) and a heart attack. 

There are basically two ways that a TIA can occur. First, a blood vessel within the brain may have been blocked by plugs of platelets or fibrin that have been dislodged. This blockage typically results from the narrowing of one of the carotid arteries (carotid arteries run upward on either side of the neck and supply blood to the brain). 

A TIA may also occur when a cholesterol-laden plaque within the blood vessels in the brain is disrupted and a blood clot forms in this area. An attempt to repair or “patch” the defect results in the blockage of blood flow. 

What are the implications

Bottom line: Anyone who has had a TIA is at risk of developing a stroke in the future. About half of the people who have a TIA will have a stroke within a year. A fifth will have a stroke within a month. 

Who’s likely to suffer from TIA

Risk factors for a TIA are similar to that of a stroke or heart disease. Hence, these include high blood pressure, diabetes, high blood cholesterol, cigarette smoking, obesity, and a family history of stroke or heart disease. 

In addition, men are generally three times at greater risk than women. The risk for TIAs also increases for those older than 45 years, and those in their 70s and 80s are at the greatest risk. 

What can you do during an attack

There’s nothing much that can be done except to get medical help immediately. Though TIAs are temporary, you can’t differentiate it between a stroke. If it is a stroke, immediate medical help can be a lifesaver. 

If you observe someone whom you suspect may be having a TIA, act quickly to get the person emergency medical help. 

Once in medical care 

The doctor will ask about symptoms and medical history. He or she will ask when the TIA spells occurred, how long they lasted, and what parts of your body were affected. 

A diagnosis can be made based on history and physical exam, combined with the presence or absence of risk factors for stroke as well as other tests and imaging studies. 

The physical examination will especially focus on the cardiovascular and nervous systems. For example, a heart problem such as irregular heartbeat, or narrowed arteries leading to the brain may be the cause. 

Tests may include an ECG (tracing of the heart), chest x-ray, and a brain scan (typically a CT scan or an MRI). Imaging studies may also be carried out to try and find the source of the problem. 

Once a TIA is identified, it is important to identify the cause and help reduce the likelihood of future attacks, or in this case, possible strokes in the future. 

For a TIA, blood-thinning medications may be given, and aspirin or aspirin-like drugs may be prescribed. Others may be given anticoagulant medications such as warfarin (Coumadin) to lower the ability of the blood to clot. 

If the carotid arteries are found to be narrowed, the doctor may discuss a procedure called a carotid endarterectomy. Plaque that may be building up inside the arteries is removed. 

Risk modifications 

It is important to recognise the risk factors to prevent future TIAs and, in consequence, stroke. For someone who has never had a TIA, it is important to minimise and eliminate underlying risk factors. High blood pressure should be controlled. This can be done with diet, exercise and even medication, if required. People with diabetes and elevated cholesterol should control their conditions. 

Keep a healthy diet that includes exercise in accordance with your physician’s recommendations. Stop smoking immediately. 

Blood-thinning drugs such as aspirin or warfarin may be prescribed to lower the risk for blood clots. The purpose of these medications is to block small clots from forming. Surgery to open potentially blocked carotid arteries may be performed. 

Reduce the amount of stress in your life with exercise, relaxation, and psychological counselling if needed. 

Take home message 

Once a TIA is diagnosed, an urgent medical evaluation is recommended. Most people should be hospitalised to complete the work-up in a timely manner. 

It is also a good idea to be alert to the possibilities that a TIA might be occurring. Someone experiencing a TIA may have a lopsided face – the face looks twisted to one side, which is especially noticeable when the person smiles. This is caused by weakness of some of the facial muscles. In addition, one side of the person’s body may be limp. The arm and leg are commonly weak at the same time, but either one can be weak by itself. The arm may dangle, or the person may favour the “normal” leg. If the person walks, a foot-drag may be noticed on the weak leg. 

When you see someone who is suddenly experiencing such problems, get medical help quickly. Don’t wait to see if symptoms go away. It could be a TIA, or even a stroke. Any TIA, no matter how long it lasts, predicts another one and could signal an impending stroke. 

The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

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