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Transforming Treatment: Understanding and Preventing TIAs

Jason Johns confers with patient
Jason Johns, center, and Lauren Eastman, right, talk with a patient

The recent stroke-related death of actor Luke Perry was shocking to many, but it also raised awareness that people of any age are at risk for stroke—not just older adults. Unfortunately, strokes are far too common. They are a leading cause of disability and the fifth leading cause of death in the United States.

Strokes happen when blood flow to the brain is interrupted. Usually they are caused by clots or cholesterol build-up suddenly blocking an artery. Less often, they are caused by ruptured blood vessels. Either way, the brain cannot get the oxygen it needs and brain cells die. 

Strokes typically affect one side of the body and cause sudden changes in speech, vision, strength, sensation, coordination and/or balance. The American Stroke Association encourages the use of FAST: Face Drooping—Arm Weakness (or tingling)—Speech (slurred or difficult to understand)—Time to Call 911 to recognize the signs of stroke.

Is it a stroke or TIA?

Sometimes referred to as “mini-strokes,” transient ischemic attacks (TIAs) have the same causes and symptoms as stroke. But for TIAs, symptoms go away because the body clears the blockage before there is permanent damage. TIAs are often very brief, in many cases less than 5 minutes.

When symptoms begin, it is difficult to say if they will go away or not. At the first sign of TIA or stroke, it’s important to seek immediate medical care. There are rescue treatments available in the emergency room that can help, including a clot busting medication (tissue plasminogen activator, or tPA) and a wire-like clot retriever (mechanical thrombectomy), but they work best when used soon after symptoms start, ideally within 3 hours or less. If there is too much of a delay, they can’t be used at all.

Because TIA symptoms go away, they are too often ignored. This is a dangerous mistake. A TIA is a warning sign that a major stroke may be on the horizon. We know as many as one third of TIA patients end up having a stroke within the next year. And up to one fourth of people who suffer a TIA die within one year. Risk Factors for TIA/stroke include smoking, diabetes, high cholesterol, physical inactivity, obesity, poor diet, and excessive alcohol intake. Heart disease, sleep apnea and other conditions can also increase your risk.

We can also think of TIAs as a golden opportunity for stroke prevention. Eighty percent of strokes are preventable if people recognize the warning signs, reduce their risk factors and get the right treatment.                                                                                                                                                                                                                                                                                         

A unique approach: Rapid Access TIA Clinic

Unfortunately, it can sometimes take weeks to months to see a neurologist who specializes in stroke care. Because the greatest risk for recurrence of a TIA or stroke is within the first few weeks, Dartmouth-Hitchcock (D-H) Neurology has adopted a new approach to ensure TIA patients get the care they deserve as quickly as possible. Their team of doctors, nurse practitioners and physician assistants recently launched a Rapid Access TIA Clinic dedicated to TIA care and Stroke prevention. Wait times to see a specialist have been cut dramatically—from an average six weeks to just three days.

In TIA clinic, patients have a personalized assessment based on their unique history and risk factors. Evaluation may include a brain MRI, blood vessel imaging of the head and neck, labs and selected cardiac tests. Providers then review results with patients, offer education and deliver evidence-based treatment care plans.

Remember, if you are worried you might be having a TIA or stroke, get emergency help right away. If you have had symptoms in the past, talk to your doctor as soon as possible. Don’t miss the chance to prevent a stroke before it happens.

For more information about the Rapid Access TIA Clinic, call (603) 650-5104.

Jason A. Johns, PA-C, is an advanced practice provider in the Neurology Department's Cerebrovascular Disease and Stroke Program at Dartmouth-Hitchcock Medical Center.