A Big Warning

Sometimes referred to as a mini-stroke, a transient ischemic attack deserves the same attention as a stroke

Do you know the signs of a stroke?

The American Stroke Association hopes that people will remember the F.A.S.T rule:

         F is for facial droop…check if one side of the person’s face droops down.
         A is for arm weakness or numbness.
         S is for speech changes…check for slurred speech or inability to speak.
         T is for time to call 911. Get the person to the hospital ASAP.

Similar symptoms occur when a clot only temporarily obstructs the flow of blood to the brain. Because such an episode can happen quickly and usually resolves itself with no permanent injury to the brain, it is sometimes referred to as a mini-stroke.

But its true name is transient ischemic attack, or TIA.

“A TIA is a focal neurologic deficit believed to be emanating from brain ischemia, which resolves completely within an hour or so,” explains Shannon Stewart, MD, a neuro-hospitalist at St. Joseph’s/Candler.  Ischemia occurs when an area is receiving inadequate blood supply due to a blockage.

“A physician would expect to find no evidence of stroke when imaging the brain of a TIA patient,” Stewart says, “because, we believe, the symptoms resolve as the brain gets blood flow back before any permanent ischemic damage is done.”

Still, a TIA needs the same response as a stroke.

“A transient ischemic attack is an emergency situation and the patient deserves the same attention and evaluation as someone who presents with permanent deficits suggesting a stroke,” Stewart says. “Unilateral weakness, numbness, slurred speech, loss of speech and sudden vision loss can all be symptoms of TIA. Anyone with those symptoms should call 911 and seek help immediately. There is no way to know if someone is having a TIA or stroke in the moment. You should not wait to see if the symptoms are going to resolve, because they may not.”

Dr. Stewart emphasizes that if patients can get to a stroke-ready hospital within a three-hour window, they may qualify for a life-saving tissue plasminogen activator, or tPA. This clot-busting treatment can improve stroke symptoms and reduce long-term disability often associated with severe stroke.

If it is determined that the patient suffered a TIA, Dr. Stewart suggests that he or she not think of it as a mini-stroke but really as a warning stroke.

“Having a prior history of stroke or TIA statistically raises the chance of a future stroke compared to patients with no history,” Stewart says.  “These patients need to seek a medical evaluation to identify their risk factors for stroke. Conditions such as carotid artery disease, atrial fibrillation, high cholesterol and hypertension should be identified and treated accordingly, along with regular follow-ups with a physician. This is the best way to prevent recurrent stroke or TIA.”

Treating TIA Through Telemedicine

Expert neurologists at St. Joseph's/Candler work in collaboration with other area hospitals through the Stroke NET-work program, an innovative form of telemedicine.  Through internet video and uploaded brain scans, neurologists in the Savannah hub can diagnose stroke or TIA patients in any of the network’s spoke hospitals. These rural hospitals do not have access to neurologists on staff twenty-hours a day, and in the past patients faced a long transport into Savannah for diagnosis and treatment. 

Telemedicine saves time that is incredibly precious. Through the Stroke NET-work, neurologists can provide the expertise to make the decision to administer clot-busting treatments such as tPA. When administered within the first three hours of a stroke, tPA gives patients a better chance to survive and recover from a stroke.

The spoke hospitals in the life-saving Stroke NET-work are:

Effingham Hospital
Wayne Memorial Hospital in Jesup
Appling HealthCare System in Baxley
Coffee Regional Medical Center in Douglas
Evans Memorial Hospital in Claxton
Candler County Hospital in Metter
Optim Medical Center – Tattnall in Reidsville

Find out more at  www.sjchs.org/strokenet

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