Posted on 03/07/2005 7:37:13 PM PST by FairOpinion
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients.
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.
Eighty percent of strokes are ischemic, caused by the narrowing of the large or small arteries of the brain, or by clots that block blood flow to the brain. They are often preceded by a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that shows symptoms similar to a stroke, typically lasts less than five minutes, and does not injure the brain.
The study examined 2,416 people who had experienced an ischemic stroke. In 549 patients, TIAs were experienced prior to the ischemic stroke and in most cases occurred within the preceding seven days: 17 percent occurring on the day of the stroke, 9 percent on the previous day, and 43 percent at some point during the seven days prior to the stroke.
“We have known for some time that TIAs are often a precursor to a major stroke,” said study author Peter M. Rothwell, MD, PhD, FRCP, of the Department of Clinical Neurology at Radcliffe Infirmary in Oxford, England. “What we haven’t been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.”
Rothwell also noted that clinical guidelines should be amended accordingly.
The study included two population-based studies (Oxford Vascular Study and Oxfordshire Community Stroke Project) as well as two randomized trials (UK-TIA Aspirin Trial and European Carotid Surgery Trial).
The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as dementia, dystonia, epilepsy, migraine, and stroke.
For more information about the American Academy of Neurology, visit http://www.aan.com.
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Mini-strokes are NOT to be ignored, urgent attention is needed, which may prevent a major, incapacitating stroke. Heed the warning.
A friend at church just had her brother die of a massive stroke. He was only 47.
How sad.
Sometimes it's a total surprise, but for those "fortunate" enough, to have a warning, they need to take it seriously -- and not just those to whom it happens, but the doctors, who also usually just brush it off.
And exactly what are the signs of a mini stroke?
Well, what are the warning signs/symptoms?? The article inexplicably left that out.
Mini-strokes can be warning signs for a major stroke. Apparently doctors didn't used to do anything, when someone had a mini-stroke, but since the study found, that they could be a precursor to a major stroke, they recommend, that within hours of a mini-stroke people receive treatment, e.g. blood thinners, to prevent a coming major stroke.
Okay. Tell us what to look for. No symptoms were described in the article.
My father had a massive stroke at the age of 37. Paralyzed on his right side and lost his speech. Died of another massive one at age 45. Left 3 kids and a loving wife and hundreds of friends and family members.
He was 6'4 185 the day he had his stroke. He went into the hosptial (this is 1977 mind you)for a physical due to chest pains and they sent him home with a bottle of maalox and told him heartburn.Meanwhile what he was having was a heart attack.
Needless to say the story does not improve from that moment onward.................
All I can say is Thank God technology is getting to the point today to where strokes as horrific as his can be prevented in a good amount of time.
I don't know what the literature says are the symptoms of TIA, but here's what I've seen: My boss apparently had an episode of TIA's, in which he suddenly found himself at work unable to speak. It freaked him out, but instead of signaling/writing to one of us in his office that he was having a problem, he just left work and DROVE HIMSELF to the hosiptal! They diagnosed that he had a TIA, and he was off of work for a week or so. He never really talked to us about it, but we did tell him he was an idiot for not letting someone know he was having a problem. Driving yourself to the hospital when you have had an incident like that is NOT SMART (well, it fits with his personality, though...)
Signs nad symptoms of a stroke:
http://www.healthsystem.virginia.edu/UVAHealth/adult_cardiac/stroksgn.cfm
The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately. Symptoms may include:
sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
sudden confusion or difficulty speaking or understanding
sudden problems with vision such as dimness or loss of vision in one or both eyes
sudden dizziness or problems with balance or coordination
sudden problems with movement or walking
sudden, severe headaches with no other known cause
All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away - take action immediately. The symptoms of stroke may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
What are some other symptoms of stroke?
Other, less common, symptoms of stroke may include the following:
sudden nausea, vomiting, or fever not caused by a viral illness
brief loss or change of consciousness such as fainting, confusion, seizures, or coma
transient ischemic attack (TIA), or "mini-stroke"
A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes to a few days. Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.
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(TIA-s are "mini-strokes")
More info on strokes and mini-strokes:
http://www.mydr.com.au/default.asp?article=2440
No historical feature distinguishes ischemic from hemorrhagic stroke, although nausea, vomiting, headache, and change in level of consciousness are more common in hemorrhagic strokes.
Common symptoms of stroke include abrupt onset of hemiparesis, monoparesis, or quadriparesis; monocular or binocular visual loss; visual field deficits; diplopia; dysarthria; ataxia; vertigo; aphasia; or sudden decrease in the level of consciousness.
Although such symptoms can occur alone, they are more likely to occur in combination.
25% of all strokes occur in people under the age of 65.
Transient Ischemic Attacks --TIAs
A transient ischemic attack (TIA) is caused by a temporary reduction of oxygenated and glucose rich blood in the brain. Generally most episodes last only few seconds to a few minutes. Basically it has the same identical origins as ischemic stroke.
TIAs are most frequently caused by atherosclerotic cerebrovascular disease. This occurs when cholesterol plaque is deposited inside the major or minor arteries which feed the brain. This plaque forms after the inner lining of an artery has been injured. The plaque causes narrowing of the blood vessels and reduced blood flow, increased the pressure of the blood within the vessel and slows blood flow down. When circulation is slowed, blood platelets tend to clump at the area of injury or blockage. This, along with the deposition of cholesterol causing the atherosclerosis buildup creates a mass which protrudes into the artery hence further slowing down blood flow and eventually either the vessel closes to no longer allow blood flow at all or a blood clot or thrombosis is created. A plaque fragment can break off and be carried by through blood stream to lodge at a distant site in the brain. These are the two main causes of a TIA.
Signs and Symptoms
Sudden onset of weakness, tingling, or numbness typically involving one side of the body.
Vision loss
Speech difficulty, vertigo, double vision, imbalance, or incoordination of the limbs.
What Risk Factors Increase the Chance of a TIA Occurring?
The major risk factors contributing to TIAs are:
High blood pressure
Certain types of heart and valvular diseases
Smoking
Diabetes mellitus</li>
Advancing age
Making The Diagnosis
The most significant symptom of TIA is the speed at which it comes and goes: rapid onset, brief
duration, and then a return to normal is the usual sequence.
Recurrence of the same or similar symptoms is also significant.
Weakness in only one arm or leg.
Final diagnosis as with stroke is based on the pattern of symptoms the type of symptoms, past medical history, family history, present signs and symptoms and findings upon a complete physician examination
Physical examination should include evaluation of both eyes and blood pressure and listening for a noise (or a bruit) which can only be heart with a stethoscope when listening over the artery which feeds the area of impairment.
Diagnostic Testing can be helpful in finalizing the diagnosis and determining the extent of the process, especially ruling out the causes of hemorrhagic stroke. The testing done, may include CAT Scan or MRI of the Head or Cerebral Arteriography to provide images of the arteries for evaluation.
How Serious Is Transient Ischemic Attack?
The signs and symptoms of TIA are very similar to those of ischemic stroke, with one important difference, that is they disappear completely within 24 hours. An individual may have one or more TIAs in the same day or they can be separated by days, week's, months or even years. Generally they will lasts no more than a few minutes.
Any TIA should be considered to be a warning sign that a stroke may follow in the near future, even within a few minutes. Approximately one-third of all persons who have TIAs will later have a stroke. A third will have more TIAs and another third will have no further cerebrovascular symptoms.
While arterial atherosclerotic plaque deposits are very common, they are not necessarily the only cause for TIA. The separate arterial networks in the brain have a built-in safety factor through extensive, small interconnections between them. When blood flow is gradually impeded in one network, these interconnections tend to enlarge so another arterial network can take over the blood supply to that region, a phenomenon called collateral circulation. As a result, a completely blocked artery may be harmless if collateral circulation is sufficient.
An additional safety factor is that the arteries to the brain are usually large enough to provide an adequate blood supply even when they are narrowed up to 75 percent by a plaque deposit. A TIA, therefore, is a warning that your safety factors are being overwhelmed.
Treatment
The purpose of treatment of TIA is primarily to prevent the occurrence of a stroke. This is done by improving arterial blood flow to the brain and so that a subsequent stroke can be avoided.
Medication:
High blood pressure must be treated and brought into normal levels.
If high blood pressure does not exist then prevention is directed primarily at reducing the risk of
any blood clots forming.
Presently the most common medication used for this purpose is aspirin. (In addition to its pain-relieving ability, aspirin also inhibits the way platelets clump together; the presence of too many platelets at a narrowed site may further compromise the flow of blood to the brain.)
The physician may prescribe it first on a trial basis. Anticoagulants (such as heparin or sodium warfarin) may be recommended in some situations. Anticoagulants or blood thinners also reduce the tendency for blood clots to form.
Surgery:
Surgery is generally a last resort and the primary surgery performed when dealing with TIAs is carotid endarterectomy. Here the arterial plaque is removed to lower the risk of further TIAs.
The ideal candidate for this operation is an individual who has one or more TIAs without complications and diagnostic testing demonstrates that these TIAs were most likely caused by atherosclerotic plaque deposits in the arteries of the neck providing blood flow to the brain. It is best if the individual has no other symptoms suggestive of a stroke.
A less than ideal person, is anyone else, especially someone with high blood pressure of symptoms of an ongoing stroke.
Your link is much better than what I posted. Thank you.
With my husband he started talking funny. Not making sense. He was already on blood thinners so they didn't do anything. Then a year later after he got up in the morning I saw him dragging himself along the kitchen counter. I got him to the emergency room and they did a cat scan. He had a small bleed in his brain. Later some dumb nurse gave him aspirin even after I questioned her. I kept telling her he is already on the blood thinner (Coumedin) She insisted it was ordered. Yes, for the guy in the other bed. It caused the bleed in his brain to go to about 3 inches. His doctor was called in and they gave him plasma. He was paralyzed on his left side and after a month in the hospital rehab he finally came home. He was very blessed in that he recovered and is able to do almost all that he used to do. He has lost a lot of weight which has been a big help.
The nurse was brought before the state licensing board. I don't know what the outcome of that was though.
My father had a seeming TIA and I took him to emergency room. (bizarrely unresponsive and out of it for about 3 minutes in public). They gave him an MRI, found nothing wrong. Part of me felt silly, but part of me knows I wouldn't have forgiven myself if there was something to it (he had a stroke years before which he partially recovered from). I'm glad to read this article now.
You did the right thing -- better safe, than sorry.
Many times doctors work on statistics, the say 95% of the time the symptoms "mean nothing", but if you happened to be in that other 5%, it's your tough luck.
When the potential consequences could be serious, it's the right thing to do to insist that they rule out the worst possibility, before assuming "it's nothing", rather than the other way around.
Well, this is freaking me out. I always blackout like that with my vision suddenly going black while I'm conscious. The doctor says I'm healthy and doesn't know what it is. Could I be having TIAs? My grandmother had two strokes and died with the second.
Or, maybe I should just change my screenname to Hypochondriac. :-)
And yet, never in the whole article do they mention what those warning signs might be.
Please, everyone be aware that TIAs can last for as little as 2-3 minutes. My mother-in-law's description of hers: I was standing in front of a mirror in the morning; it was as though a shade was pulled down in front of my eyes, which lasted only a minute or two. The second one a few days later: the right side of my face went numb for a few minutes, like a shot of Novocaine at the dentist. Instead of going to the emergency room, she decided to take a nap. Since she felt fine, she passed it off as being overly tired. About a week later she suffered a stroke that left her paralyzed on one side for many months. She was 57.
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