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When a Dizzy Spell is a Warning Sign

TIA: A Golden Opportunity to Prevent Stroke


You've been gardening on a warm day, and you suddenly experience confusion and dizziness. You don't know where you are or what you're doing. The disorientation lasts a few minutes and then passes. Relieved, you walk into the air-conditioned house, pour yourself a glass of water and resolve to garden in cooler weather next time.

Sounds innocent enough, but this type of "spell" could actually be a transient ischemic attack (TIA) and an important early warning sign that you are at risk for stroke.

What are the symptoms of a TIA?

Marc Schermerhorn, MDThe symptoms of a TIA are the same as those experienced during an actual stroke, but they last for just a short time. In fact, TIAs are sometimes called mini-strokes.

"Unlike a stroke, TIA symptoms are brief - usually spanning seconds to a few minutes," said Dr. Marc Schermerhorn, Chief of Vascular Surgery at Beth Israel Deaconess Medical Center's CardioVascular Institute.

The signs of a TIA or stroke include one or more of the following symptoms:

  • Weakness on one side of the body, such as the face, an arm or a leg
  • Difficulty in speaking or understanding
  • Partial or complete loss of vision in one or both eyes
  • Dizziness or loss of balance and coordination

While these symptoms don't last long and may be mild, they are serious warning signs for stroke. And while the body is experiencing these signs, there's no way to know whether it's a stroke or a TIA without physician intervention. That's why anyone experiencing TIA symptoms should get to a hospital emergency department as soon as possible.

Magdy H. Selim, MD, PhD"Up to 25 percent of stroke patients have experienced a TIA in the past," said Dr. Magdy H. Selim, Co-Director of BIDMC's Stroke Clinic and Associate Professor of Neurology at Harvard Medical School. "On average, for those who experience a TIA, 8 percent will have a stroke within a month, 12 percent within a year and 30 percent within five years."

What causes a TIA?

A TIA occurs when blood stops flowing to an area of the brain for a brief period of time. This usually happens when there is low blood flow in a major artery that carries blood to the brain, like one of the carotid arteries, which are located on both sides of the neck. TIAs can also result when a blood vessel in the brain is blocked by plaque build-up or by a blood clot that has traveled to the brain from elsewhere in the body.

Top risk factors linked to stroke are:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Smoking
  • Atrial fibrillation or irregular heartbeat
  • Family history

The common denominator for many of these risk factors is atherosclerosis (another name for plaque build-up). Atherosclerosis occurs when inner layers of arteries are damaged due to high levels of blood pressure, cholesterol or sugar (from diabetes or insulin resistance) in the blood or smoking. Plaque can accumulate on the inside of damaged arteries, restricting blood flow and, if the plaque ruptures, causing blood clots to form.

What are treatments for TIA?

TIA management is aimed at preventing a future stroke, the number three killer and leading cause of disability in the United States. If evidence of atherosclerosis or carotid artery blockage is found, treatment may include the use of medications such as statins to lower cholesterol and blood-thinning medications (antiplatelets such as aspirin or anticoagulants) to help prevent blood clots from forming.

For severe narrowing of the carotid artery, a vascular surgeon can open the artery and remove plaque. Some vascular surgeons also perform a newer, endovascular (non-surgical) procedure called carotid stenting, in which a small wire mesh tube is placed within the plaque-lined artery to keep it open.

Even so, a preventive approach remains essential. Atherosclerosis is a chronic and incurable disease, according to Dr. Schermerhorn, who performs both surgical and endovascular procedures.

"As with any chronic disease, slowing down its progress is the key to extending health," he says. "Surgery to open the artery is an option. And lifestyle changes can make a significant difference in the amount of plaque build-up and the frequency of procedures required to treat it. You can't cure it, but you can manage it and slow down the process. Surgery can open an artery, but lifestyle changes can help avoid the plaque building back up again and requiring further procedures."

Measures to reduce risk for carotid artery disease and stroke include a healthy diet and weight, regular exercise and not smoking. Medications may be needed to aggressively treat diabetes, high blood pressure or high cholesterol levels.

"Recovery from stroke is a long process. We do our best with patients, but sometimes the damage is permanent," said Dr. Selim. "A TIA can be a once in a lifetime chance to decrease your risk of a disabling stroke. It's a golden opportunity to build healthy habits into your lifestyle and, if needed, to take advantage of medical interventions like surgery or medication."

Posted August 2011

Contact Information

CardioVascular Institute at
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
888-99-MYCVI
617-632-9777

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