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For Stroke, call 9-1-1

Call 9-1-1 immediately if you experience or witness stroke symptoms.

Published on May 17, 2017

Don’t ignore this warning sign of impending dangerDon’t ignore this warning sign of impending danger

Have you experienced an episode of weakness on one side, dizziness, vision changes or other subtle symptoms and shrugged it off as unimportant? If so, you may be putting your life in danger.

A recent survey by the American Heart Association (AHA) showed that one-third of adults in the U.S. have had symptoms of a mini-stroke or Transient Ischemic Attack (TIA) and most did not call 911.

Of the 2,040 adults surveyed, 35 percent of them had at least one symptom of a TIA and they waited or rested until the symptoms subsided instead of calling for help.

While the warning signs of a TIA may seem minor, they can be a sign of an impending stroke.

“A lot of people assume that their symptoms will go away,” said Ahmad Abokhamis, MD, a neurologist at Cape Cod Hospital. “Sometimes symptoms happen in the middle of the night and instead of calling the ambulance, they just go back to sleep and hope they will be gone in the morning. What many people don’t realize is that even if the symptoms subside they can go on to have a stroke within 24 hours.”

TIA Symptoms

A TIA is caused by a brief blockage of blood flow to the brain, according to the AHA. The onset of symptoms can be sudden and include:

  • Numbness or weakness on one side of the body
  • Confusion, trouble speaking or understanding conversation
  • Decreased vision in one or both eyes
  • Difficulty walking
  • Dizziness
  • Loss of coordination or balance

“TIA by definition is when the stroke symptoms resolve within 24 hours although they usually resolve within the first hour,” said Dr. Abokhamis. “The problem is we can’t make that assumption. A lot of the time people present with subtle symptoms and assume it’s a TIA because they may fluctuate or resolve initially, but then the symptoms come back.”

The diagnosis of a TIA is essentially by process of elimination, according to Dr. Abokhamis.

“The head CT scan is the fastest initial study done to rule out a bleed in the brain [that would be causing the stroke],” he said. “This is followed by a Magnetic Resonance Imaging (MRI), which is the gold standard for confirming or ruling out an acute stroke. If the MRI is negative, it is very unlikely that it was a stroke but it could still be a TIA.”

While the patient may be relieved to know that they didn’t have a stroke, they will still be admitted to the hospital for 24 hours of observation, he added.

“The main reason we admit patients is, depending on the location of the symptoms and the likeliness it was a true TIA, the chances of it evolving into a stroke continues to be high in the first 24 hours,” said Dr. Abokhamis. “And that continues to be possible for up to 90 days after a TIA.”

The other reason a patient is admitted is to do a TIA/stroke workup, he said. Tests include a carotid Doppler exam to check the carotid arteries for any abnormal narrowing that could affect blood flow to the brain and an echocardiogram to rule out any heart source of clots. Narrowing of the arteries and changes in the heart can lead to clots that could travel to the brain and cause a stroke.

Patients who have had a TIA are educated on lifestyle changes, management of risk factors and medications to prevent strokes.

Risk Factors For a TIA

  • Age
  • Male gender
  • Hypertension (high blood pressure)
  • Dyslipidemia (high triglyceride levels)
  • Diabetes
  • Smoking

The importance of differentiating between a stroke and a TIA is key and the time of onset of symptoms is one of the pieces of information that is critical for successful treatment in the event of a stroke.

“The time of onset of symptoms is determined by the last time the patient seemed normal,” said Dr. Abokhamis.

The treating medical team must have this information. If not, then the window of opportunity during which a stroke patient could be treated with the clot-busting drug, tPA, (Atleplase) may be gone, he said.