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Don't brush off signs of a "brain attack"

DEC 2013

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Stroke symptoms that go away on their own are still a medical emergency. Get to a hospital as fast as you can.

Every stroke is a medical emergency because it means that blood flow to part of the brain has been interrupted. Everyone needs to be able to recognize the signs of a stroke and get to a hospital fast because "time is brain." The longer you wait, the more brain cells could die.

Surprisingly, many people fail to act on a warning signal that a major stroke is in progress or may be on the way. It's called a transient ischemic attack (TIA). The symptoms of stroke and TIA are similar except for one important thing: TIAs go away on their own, tempting many people to avoid a trip to the ER.

That can be a disastrous decision, since there is a one-in-10 chance of having a major stroke in the two days after a TIA—and the risk remains elevated for months. "We really discourage people from the ‘wait and watch' approach if they have any symptoms that suggest a stroke," says Dr. Shruti Sonni, a neurologist at Harvard-affiliated Cambridge Health Alliance. "A TIA is a warning sign. It says you are at risk for something worse to happen."

For the best protection from stroke, match your wariness for stroke signs with changes in lifestyle to reduce the risk of having a brain attack in the first place. In general, anything that is good for your heart is also good for your brain.

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What is a TIA?

A stroke is a persistent, interruption of blood supply to the brain. It can happen when an artery in the brain ruptures and bleeds (hemorrhagic stroke) or when a clot blocks an artery feeding the brain (ischemic stroke). Both cut the flow of oxygen and nutrients, causing brain cells to die. A TIA is the same sort of blood-flow interruption, but only a temporary one.

Ischemic stroke is like a heart attack from a blocked coronary artery; think of a TIA as a small "brain attack." A person may feel any of the typical stroke warning signs during a TIA, lasting from minutes to several hours. But in that time a TIA can cause significant damage. In fact, many events that were once thought of as TIAs would today be considered strokes.

Stroke or TIA can cause a variety of symptoms. Experts developed the "FAST" memory aid (see above) to highlight some of the more obvious signs of a brain attack. Here is a more complete and detailed list:

  • Face drooping. One side of the face goes slack. A smile appears uneven.

  • One arm is weak. When raising both arms, one arm drifts downward.

  • Numbness. Loss of feeling on one entire side of the body, or part of the body, such as the face, an arm, or a leg.

  • Speech difficulties. Inability to find words or understand what is spoken, or slurring of speech.

  • Vision trouble. Blurred vision, double vision, or loss of vision in one eye.

Other possible signs of stroke include dizziness, loss of balance, or sudden and severe headache. Especially if the symptoms are sudden and hard to explain, take them seriously. And don't ignore stroke symptoms even if you think you might have experienced them before. It's possible to experience multiple TIAs before having a major stroke.

Delaying tactics

Because TIA symptoms may be milder than those of a major stroke and may go away on their own, too many people delay in seeking medical attention. "People worry more about things that start and don't stop," Dr. Sonni says. "They might just brush it off because they feel better in a few hours."

Also, some people may try to explain away symptoms, attributing arm numbness to having "slept funny" the night before or blurry vision to low blood sugar from missing a meal. But that is risky. "You never know what you are dealing with," Dr. Sonni says. "You don't know if it's a TIA or a stroke, and just because the symptoms are milder doesn't mean they are going to go away."

Another reason why TIAs sometimes don't receive timely medical care is that stroke affects mostly older people, many of whom already have some other medical condition they might blame for their stroke warning signs. Even if you are not sure if something is a stroke symptom, act as if it is. "You can't be too careful," Dr. Sonni says. "This is something that could leave you seriously disabled and dependent and not the same person you were."

Lower your risk of stroke now

Stroke risk rises with age, and there is much you can do to lower your risk. A heart-healthy diet and lifestyle is essential. This includes:

  • If you smoke, stop.

  • Do something active for at least 30 minutes a day on most days of the week.

  • Lose weight, if you are overweight.

  • Eat a diet rich in fruits, vegetables, and lowfat dairy products and reduce consumptions of meats, sweets, and refined grains (such as white bread or white rice).

  • Eat less salt (sodium).

    Limit the amount of alcohol you drink to no more than two standard alcoholic drinks per day for a man and one for women.

Speed matters

Prompt action has a few important benefits. For one thing, you could find out that you are not actually having a stroke. Another possibility is that you could be in the early stages of a major stroke, and emergency medication can open up the blocked artery and nip the problem in the bud. The right medical care and drug therapy can prevent additional TIAs and strokes in the future.