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home : columns : ask the doctors May 29, 2020

3/4/2020 8:11:00 AM
Ministrokes require immediate medical care

Dear Doctor: Our mom had half of her face go numb for a few minutes, and she also had trouble speaking. She went to the doctor and was told she had a ministroke. What is that? Is it dangerous?

Dear Reader: Your mother had what is known as a transient ischemic attack, or TIA. This occurs due to a temporary decrease or blockage of blood flow within the brain. The words "mini" and "temporary" sound reassuring, and, in fact, people tend to shrug off a TIA because the symptoms often improve quickly. However, a TIA is a strong warning sign of elevated stroke risk, which makes it a medical emergency. Up to 15% of patients go on to have a more severe stroke in the three months following a TIA, with half of those occurring within the first 48 hours after the initial event. Statistics show that long-term stroke risk is elevated as well.

The symptoms of a TIA are similar to those of a major stroke. They include weakness, numbness or sudden paralysis of the face, arm or leg, which usually involves just one side of the body; slurred or confused speech; difficulty understanding spoken and written language; changes to vision; dizziness; difficulty walking or standing; and the swift onset of a severe headache. Unlike in a stroke, the symptoms associated with a TIA are brief. They can last up to 24 hours, but in many cases they pass within the hour. In some people, as with your mother, the symptoms last for mere minutes.

It's this short-lived nature of a TIA that causes up to one-third of patients to put off seeking medical care for more than 24 hours. Risk factors include high blood pressure, heart disease, diabetes, being 55 or older, having a family history of stroke, having had a previous stroke or TIA, the use of tobacco products and being overweight. TIAs occur more often in men than in women, but due to their longer life spans, the mortality rate is higher in women. Genetics, race and a poor blood lipid profile also play a role.

If you have the symptoms of a TIA, it's important to seek medical care immediately. Diagnosis includes a complete medical history, physical exam and one or more of a variety of scans and imaging tests to evaluate the relevant blood vessels. Treatment may include the use of medications to lessen the risk of clotting, to dissolve existing clots, to lower blood cholesterol and to address any blood pressure issues. In some cases, angioplasty to open a clogged artery, or the use of a stent to prop open an artery, may be recommended. When severe blockage is found, surgery to clear the artery may be needed. The treatment approach is determined by the cause, location and severity of the TIA, as well as each patient's medical status and history.

The reassuring news is that, with prompt and proper medical care, up to 80% of the strokes that occur after a TIA are preventable. That makes early diagnosis and immediate treatment all the more important.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.





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