Stroke

One of my friends has had a number of ministrokes. As we sat down for lunch he told us that the previous problems, which we had attributed to mixing medication and booze, was in fact due to a miinistroke. He said the Doctor told him that he had a mini-stroke, or a Transient Ischemic Attack (TIA) as the Doctors call it, and so he was not too concerned. This is the third mini stroke that he has had in the past two years.  

A Transient-Ischemic Attack or “mini-stroke” is when a blood clot stops blood from flowing to the brain for a short time. Effects are short-term, or transient. The brain returns to normal.

I am worried about my friend because the stats are not good: More than 1/3 of people who have a TIA are expected to eventually suffer a stroke although studies may vary, up to 20% of these people will suffer a stroke within 90 days.

What happens in a TIA?

Part of the brain can not receive blood anymore, so it becomes starved of oxygen and nutrients.  This is called ischemia.  It caused my friends’ abnormal behaviours.  

The brain needs blood to survive as blood contains oxygen and nutrients needed by the brain. Th blood flows from the heart, up through lots of arteries, which branch out into the brain.

How a blood clot can form

Over many years, fat and cholesterol in the blood can stick to the artery wall, gradually building into a plaque. The artery becomes increasingly stiff and narrow This process is called atherosclerosis. Part of the plaque can break off forming a blood clot, this blood clot flows through the artery towards the brain, where it gets stuck in one of the smaller arteries.

As part of the brain cannot receive blood anymore, so it becomes starved of oxygen and nutrients.  This is called ischemia.  This is what caused my friend`s abnormal behavior’s.  For my friend the world flipped upside down, and everything he saw was upside down. It took a few minutes for his world to right itself, but when it did, he did not go seek medical help. He continued on as normal. It was only at his next regular visit to his doctor that he told the her about this event. He was tested and it was determined that he had a stroke.

What should you do if you suffer a mini-stroke

Never drive yourself or the person having a stroke or TIA to the hospital. CALL AN AMBULANCE.  Ask to be taken to the closest hospital that provides expert stroke care. You should be seen quickly after arriving at the hospital. If possible you should receive a brain scan to find out if your symptoms were caused by a blood clot or bleeding into your brain.

Who is at risk factors for a mini-stroke?

Here are risk factors cannot be controlled:

·       Age – most occur over age 65

·       Gender – after menopause women have a higher risk than men

·       Ethnicity – First Nations, African, Southeast Asian

·       Family history – higher if others in the family have experienced TIAs or strokes

·       History of stroke or TIA – you have had a previous incident

Risk factors you can do something about:

·       High blood pressure (hypertension)

·       High blood cholesterol

·       Heart disease atrial fibrillation

·       Diabetes

·       Being overweight

·       Excessive alcohol consumption

·       Physical inactivity

·       Smoking

·       Stress

Like my friend, the symptoms and signs of a TIA will have gone away by the time you get to the hospital or see your doctor, so the TIA diagnosis may be made based on your medical history alone.

If you have had a TIA within the last 48 hours, you will likely be admitted to the hospital so that doctors can search for the cause and observe you.

 A complete neurological examination involves testing your language and memory skills; your behaviour, alertness, vision, and eye movements; your muscle control; your ability to walk (gait); and your sense of touch.

An abnormal sound called a bruit may be heard when listening to the carotid artery in the neck or other artery. A bruit is caused by irregular blood flow which could mean a blockage in the artery

Blood tests are done to learn whether there is anything in your blood that would tell your doctor what caused your TIA. Your blood may be tested for cholesterol and triglyceride levels, blood sugar level, and abnormalities in blood clotting.

The good news for my friend is that TIAs do not cause lasting damage to the brain. However, they are a warning sign that he may have a true stroke someday. He can reduce your chances of a future stroke by following-up with his health care team to manage his risk factors.

In addition, he can do the following to help himself. He can stop eating at McDonalds and lose some weight, exercise more, the recommended amount for our age is 150 minutes per week. Start eating well and follow the Canada Food Guide. He is starting to drink less alcohol. The recommended amount is 9 drinks a week for women, 14 for men. Lucky, he does not smoke, but if he did he could quit smoking. All of want him to retire, as he is still working albeit part time, to reduce his stress. And finally he should make a plan with the doctor to monitor and hopefully prevent him having a major stroke.