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.
Symptoms of a TIA
The 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
"Unlike a stroke, TIA symptoms are brief - usually spanning seconds to a
few minutes," says
Dr. Marc Schermerhorn
(right), Chief of
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.
"Up to 25 percent of stroke patients have experienced a TIA in the past,"
Dr. Magdy H. Selim
(right), Co-Director of BIDMC's
and Associate Professor of Neurology at Harvard Medical School. "On
average, for those who experience a TIA, eight percent will have a stroke
within a month, 12 percent within a year and 30 percent within five years."
Causes of 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
Atrial fibrillation or irregular heartbeat
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
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
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
"Recovery from stroke is a long process. We do our best with patients, but
sometimes the damage is permanent," says 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
Above content provided by the CardioVascular Institute at Beth Israel
Deaconess Medical Center. For advice about your medical care, consult