Transient Ischemic Attacks
TIAs or transient ischemic attacks are brief reductions in brain blood flow and oxygen known as “mini strokes” lasting minutes to hours. They occur more often in those at risk for cardiovascular disease (treatable circulation impairments or damage, anywhere from your head to your toes) now seen in younger patients due to genetic and environmental issues. TIAs must be differentiated from or overlap with heart disease, migraines, syncope, seizures and brain tumors.
Although TIAs are brief, one third of patients will have a stroke within 5 years. Symptoms are most commonly due to treatable damage in the neck (carotid) arteries, brain vessels and/or due to heart problems, especially damaged valves. The symptoms will vary depending on where the problem is located. Symptoms are due to blood vessel spasms, blockages or clots, especially micro clots that are diagnosed with special tests.
Symptoms include vision changes, balance problems, dizziness, vertigo, numbness, extremity weakness, speech problems, facial weakness and/or the sense you may pass out or actually passing out.
Women, obese patients, those with abnormal insulin or glucose, cardiac metabolic syndrome, silent kidney problems and younger patients are very tricky to diagnose because they have minimal or unusual symptoms.. Only 1/3 of women develop classic symptoms. Symptoms in women are often fatigue, anxiety, sleep problems, indigestion, and/or vague breathing problems. Patients often have abnormal tests that are downplayed or dismissed by clinicians.
Overlapping problems can include high or low blood pressure, neck, jaw, shoulder or arm pain, chest pains, irregular heart beats, leg symptoms, erection problems, etc. Past or relapsing infections, smoking, use of (estrogen, anti inflammatories, anti depressants, others), circulation problems, lack of exercise, high cholesterol, cancer, memory or cognition problems and family history of diabetes, circulation problems, cancer or kidney disease should raise suspicions and warrant thorough testing.
The diagnosis is made with lab tests (blood count, glucose, insulin, sed rate, CRP, LP PA2, cholesterols, antibody levels, etc.), clotting tests (PT, PTT, ISAC), anti-phospholipids and others. An ECG and cardiac ultrasound (echocardiogram) helps to find treatable heart and valve problems. IMT carotid ultrasound is best for diagnosing treatable carotid artery problems while regular carotid ultrasound is best for telling if you need surgery. Brain CT or MRI can help to find major strokes and diagnoses mini strokes if ordered, run and interpreted correctly.
Because a TIA may indicate an impending stroke, anti platelet therapy is started. Blood pressure, circulation and heart therapy is started. Correction of immune and metabolic problems, such as sub clinical infections, silent kidney disease, glucose, insulin or cholesterol is started. There are conventional and alternative treatment options. Lifestyle changes are encouraged to manage or reverse underlying causes. Surgery is reserved for severe cases. Treatment improves survival rate, which means controlling symptoms, decreased risk for stroke or cardiovascular disease, limiting hospitalizations and pharmaceutical use while promoting longevity.
David Overton, PA-C works at Natural Medicines & Family Practice integrating conventional and alternative treatments under the supervision of Dr. Richard Faiola, MD, ABFM. 360-357-8054.