Understanding transient ischemic attacks
by David Dunaief
Nov 27, 2018 | 665 views | 0 0 comments | 45 45 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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A transient ischemic attack (TIA) is sometimes referred to as a ministroke. This is a disservice, since it makes a TIA sound like something that should be taken lightly.

Ischemia is reduced or blocked blood flow to the tissue, due to a clot or narrowing of the arteries. Symptoms may last less than five minutes.

However, a TIA is a warning shot across the bow that needs to be taken very seriously. It may portend life-threatening or debilitating complications that can be prevented with a combination of medications and lifestyle modifications.

TIA is diagnosed in up to 500,000 Americans each year. The operative word is “diagnosed,” because it is considered to be significantly underdiagnosed.

TIA has a rapid onset with potential to cause temporary muscle weakness, creating difficulty in activities such as walking, speaking and swallowing, as well as dizziness and double vision. TIA incidence increases with age.

Potential complications range from increased risk of stroke to heightened depressive risk to even death. Despite the seriousness of TIAs, patients or caregivers often delay receiving treatment.

Stroke risk

After a TIA, stroke risk goes up dramatically and immediately. Over the long term, the probability that a patient will experience a stroke reaches approximately 30 percent after five years.

The EXPRESS study looked at the effects of immediate TIA and minor stroke treatment on recurrent stroke. The Phase 1 cohort was assessed within a median of three days of symptoms and received a first prescription within 20 days.

In Phase 2, median delays for assessment and first prescription were less than one day. All patients were followed for two years after treatment. Phase 2 patients had significantly improved outcomes over the Phase 1 patients: 90-day stroke risk was reduced by 80 percent.

The moral of the story is treat a TIA as a stroke should be treated; the faster the diagnosis and treatment, the lower the likelihood of complications.

Heart attack

In an epidemiological study, the incidence of a heart attack after a TIA increased by 200 percent. These were patients without known heart disease.

Interestingly, the risk of heart attacks was much higher in those over 60 years of age and continued for years after the event. This is an insidious effect; the average time frame for patients was five years from TIA to heart attack. Even patients taking statins to lower cholesterol were at higher risk of heart attack after a TIA.

Depression

A study of over 5,000 participants published in the medical journal Stroke found that TIA was associated with an almost 2.5-times increased risk of depressive disorder. Those who had multiple TIAs had a higher likelihood of depressive disorder. Unlike with stroke, in TIA it takes much longer to diagnose depression, about three years after the event.

What can you do?

Awareness and education are important. While 67 percent of stroke patients receive education about their condition, only 35 percent of TIA patients do. Many risk factors are potentially modifiable, with high blood pressure being at the top of the list, as well as high cholesterol, increasing age (over 55) and diabetes.

Secondary prevention (preventing recurrence) and prevention of complications are similar to those of stroke protocols. Medications may include aspirin, antiplatelets and anticoagulants.

Lifestyle modifications include a Mediterranean and DASH diet combination. Patients should not start an aspirin regimen for chronic preventive use without the guidance of a physician.

If you or someone you know has TIA symptoms, the patient needs to see a neurologist and a primary care physician and/or a cardiologist immediately for assessment and treatment to reduce risk of stroke and other long-term effects.

For more information, visit medicalcompassmd.com or consult your personal physician.
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