To Your Health: NFL coach’s episode puts spotlight on TIAs
BY DR. KEVIN FAGAN November 19, 2013 12:54PM
Dr. Kevin Fagan is a board-certified neurologist at Ingalls Memorial Hospital. | Supplied photo
Updated: December 21, 2013 6:08AM
The recent news that football coach Gary Kubiak, of the Houston Texans, suffered a transient ischemic attack (TIA) during an NFL game has put the spotlight on this serious health issue and left many wondering if they might be at risk, too.
While TIA often is labeled “mini-stroke,” it is more accurately characterized as a “warning stroke.” And it’s a warning that should be taken very seriously.
Why? Because about 1 in 3 people who have a TIA eventually will have a stroke, with about half occurring within a year after the initial attack.
The underlying cause of a TIA is a buildup of cholesterol-containing fatty deposits called plaques in an artery or one of its branches that supplies oxygen and nutrients to the brain. Plaques can decrease the blood flow through an artery or lead to the development of a clot. Other causes include a blood clot moving to the brain from another part of the body, most commonly from the heart.
The only difference between a stroke and TIA is that with TIA the blockage is transient or temporary. TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.
Symptoms of a TIA
The American Stroke Association recommends the acronym FAST as an easy way to remember the signs, symptoms and action to take for a stroke or TIA:
■ Face drooping.
■ Arm weakness.
■ Speech difficulty.
■ Time to call 911.
Other traditional symptoms include numbness or paralysis in your face, arm or leg, typically on one side of your body; slurred or garbled speech or difficulty understanding others; sudden blindness in one or both eyes or double vision; and dizziness or loss of balance or coordination.
You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved. If signs and symptoms last longer than 24 hours or cause lasting brain damage, it’s considered a stroke.
The most important thing to remember is to seek immediate medical attention if you suspect you or someone else has had a TIA. Prompt evaluation and identification of potentially treatable conditions can help you avoid a stroke.
The No. 1 risk factor for TIA and stroke is high blood pressure. Other risk factors include high cholesterol; atrial fibrillation, an irregular and often rapid heart rate that causes poor blood flow to the body; smoking; diabetes; a family history of stroke; obesity; African-American ethnicity; and advancing age, especially over age 55. People who have heart disease or poor blood flow in their legs are also more likely to have a TIA or stroke. Overall, men are more at risk for TIA and stroke, but more women die from stroke than men.
The good news is that you can control many of your risk factors through positive lifestyle changes. To begin with, if you smoke, quit. If you need help quitting, talk to your doctor about medication or behavioral programs such as the Freedom from Smoking program offered through the Ingalls Wellness Center in Flossmoor.
Make sure you have any existing health problems treated. Manage your high blood pressure or cholesterol by working with your doctor. Manage your diabetes by keeping your blood-sugar levels within a target range. If your doctor advises you to take a daily aspirin or blood thinner, take it. Take all medication exactly as prescribed. Eat foods that are low in fat and sodium. Limit alcohol consumption to two drinks a day for men and one for women. Maintain a healthy weight, and exercise for at least 30 minutes most days of the week.
Treatment for TIA
Diagnosing a TIA can be a challenge because the symptoms may have already gone away by the time the patient seeks medical attention. Diagnosis usually involves a review of the patient’s medical history and a physical exam (including a short neurological exam). If your health care provider still suspects a TIA, diagnosis then usually involves blood tests, CT or MRI scans, an ultrasound of the carotid (neck) artery to check for possible narrowing, and an electrocardiogram.
Once your doctor has determined the cause, the goal of treatment is to correct the abnormality and prevent a stroke. Treatments include medication to reduce the tendency for blood to clot, or surgery or a balloon procedure (angioplasty) to reopen a blocked or narrowed carotid artery.
Doctors use several medications to decrease the likelihood of a stroke after a TIA. The medication selected depends on the location, cause, severity and type of TIA. Two frequently prescribed types of drugs are antiplatelet drugs, which make circulating blood cells less likely to stick together; and anticoagulants or blood thinners such as Coumadin. The most frequently prescribed and least expensive antiplatelet drug is aspirin. It also carries the fewest side effects. An alternative to aspirin is Plavix.
If you have a moderately or severely narrowed carotid artery, your doctor may suggest carotid endarterectomy, a preventive surgery that clears carotid arteries of fatty deposits before another TIA or stroke can occur. An incision is made to open the artery, the plaques are removed, and the artery is closed.
In certain cases, a procedure called carotid angioplasty, or stenting, is an option. This procedure involves using a balloonlike device to open a clogged artery and placing a small wire tube (stent) into the artery to keep it open.
Afterward, adopting and maintaining a healthy lifestyle are key to avoiding another TIA or full-blown stroke.
For an easy first step at determining your risk factors for TIA or stroke, Ingalls offers a free online risk assessment called StrokeAware. This seven-minute survey helps assess and identify your potential risk for stroke, heart disease, diabetes and vascular disease.
To take the online screening, visit www.Ingalls.org/StrokeAware, or call Ingalls Care Connection at (708) 915-2273.
Dr. Kevin Fagan is a board-certified neurologist at Ingalls Memorial Hospital, which is a member of the Southland Health Alliance.