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Why you should heed a ministroke

Transient ischemic attacks, or TIAs, can signal an impending stroke, but prompt care can minimize damage.

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Image: FlairImages/Thinkstock

Have you ever experienced a brief episode when your body seemed to be a little off—your vision was blurry, your speech slightly slurred, or one side of your body felt weaker than the other? If so, you may have experienced a transient ischemic attack (TIA), says Dr. Natalia Rost, a neurologist at Harvard-affiliated Massachusetts General Hospital. She notes that many women may assume they have suffered a migraine and get back to life as usual once the episode has passed. In fact, a TIA is a serious medical issue and warrants getting immediate treatment.

Immediate treatment is key

Having a TIA is usually a sign that you may have already endured a few “silent strokes”—interruptions of blood flow to the brain—and may have accumulated some brain damage as a result, Dr. Rost says. However, getting prompt attention for a TIA can significantly reduce your chance of having a major stroke and incurring greater damage.

A team of French researchers reported in April 2016 that people who received care from a stroke specialist within 24 hours of a TIA had only a 4% risk of having a major stroke within the next three months, compared with the average risk of 12% to 20%. Recent studies also show that people who got prompt treatment from stroke specialists in the hospital or clinic were much more likely to get the appropriate follow-up treatments, including aspirin, blood thinners, and blood pressure medication. “Just as getting prompt treatment for chest pain minimizes damage from a heart attack, getting help for a TIA diminishes the effects on the brain,” Dr. Rost says.

Yet studies have shown that women aren’t as likely as men to get brain-sparing treatments. A 2013 study indicated that gender discrimination wasn’t the problem; women were less likely than men to seek help within four hours of the start of symptoms, when clot-busting therapies are most effective. Women who sought help within four hours received the same treatment as men did.

Why white matter really matters

Having a TIA often means that you’ve already sustained some damage to the brain’s white matter. This tissue, located deep in the brain, contains nerve fibers that carry impulses to nerve cell bodies in the gray matter on the brain’s surface. In essence, white matter is the brain’s transit system and grey matter its processing center.

Neurologists have detected changes in white matter that indicate unrecognized damage caused by high blood pressure or blocked arteries. Once there’s a critical mass of such “silent” injuries, people often have TIAs or strokes.

“The burden of silent disease is really underappreciated,” Dr. Rost says. Damage to white matter is not only implicated in a fifth of all strokes. but also thought to contribute to 45% of dementia cases. White-matter damage can slow reaction time and impede connections between brain regions involved in planning, organizing, and problem solving.

What you should do

Dr. Rost suggests doing everything you can to minimize white-matter damage—controlling your blood pressure, cholesterol, and blood glucose are important. So is a lifestyle that includes regular exercise, a healthy diet, and not smoking. “While it’s important to get help for a TIA, it’s better to avoid one altogether,” Dr. Rost says.

Posted by: Dr.Health

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