Is it a stroke or something else?

Transient ischemic attacks (TIA) may sound like battles in a fantasy galaxy far, far away, but in our reality here on earth, they are physical symptoms that can be warning signs of a stroke, a more serious condition.

“A transient ischemic attack is an episode of neurological dysfunction, which affects how the brain sends and receives information, and is caused by a temporary loss of blood flow to the brain or spinal cord, often due to a blood clot from the heart or other blood vessel,” said Alba Coraini, MD, a Cape Cod Healthcare neurologist with Neurologists of Cape Cod. “A TIA can be a precursor to a stroke, when the clot completely blocks the artery.”

According to the American Heart Association, a transient ischemic attack occurs before 15 percent of all strokes and approximately 240,000 Americans per year have a TIA. Around one-third of those who have a TIA go on to have a stroke within a year.

Symptoms of a Transient Ischemic Attack

The symptoms of a TIA and a stroke are very similar, which is why it is important for anyone experiencing these symptoms to call 911 and be taken to the emergency room for an evaluation, said Dr. Coraini.

The following is a list of symptoms:

• Speech changes, including trouble speaking or understanding speech, slurred speech.
• Loss of vision in one eye or “blind spots’ in the visual field.
• Double or blurred vision
• Muscle weakness or tingling/numbness especially if on one side of your body.

Causes of a TIA

There are three things that can contribute to a TIA, according to Dr. Coraini.

• A blood clot that travels from another part of the body blocks an artery in the brain temporarily and dissolves.
• Low blood flow to a major artery in the brain that may be caused by low blood pressure.
• Narrowing of an intracerebral artery caused by a cholesterol plaque (a fatty substance) build-up.

Evaluation in the Emergency Department

You can expect many tests after you arrive in the emergency department, said Dr. Coraini. These will include brain imaging, usually CT (computed tomography) scan and then MRI (magnetic resonance imaging); vessel imaging (angiography) to look at the blood vessels in the brain; a cardiac evaluation, cardiac ultrasound (echocardiogram) to assess any heart problems; and bloodwork to assess basic lab studies.

The MRI will show if there is an ischemic stroke (brain infarction), which is often associated to a partial or complete blockage of an artery causing brain cells to die. If so, then the diagnosis is a stroke and not a TIA, according to Dr. Coraini.

Once all the tests are completed and if you have had a TIA, you will need close follow-up with a neurologist and a cardiologist following your discharge from the hospital, she said. Your neurologist and/or cardiologist will create a treatment plan for any pre-existing diseases you may have, including high blood pressure, high cholesterol levels, cardiovascular disease, and diabetes.

You may need to take anti-platelet or anticoagulant medications to prevent blood clot formation in the future. If you have high cholesterol, which can cause the formation of plaque in your arteries, your cardiologist may prescribe medications to lower your cholesterol levels, such as statins, and antihypertensive medications to lower your blood pressure.

Dr. Coraini also recommends lifestyle changes including weight loss, smoking cessation, increase in exercise as tolerated and reducing alcohol consumption.

“We see many people who have TIAs; it is very common,” she said. “There is no infarction or permanent damage, however they are at increased risk of recurrent TIAs or stroke, so it is very important that they follow up with neurology.”