Is it a TIA or an Ischemic Stroke?

Author: Jack C. Rose, MD

Specialty: Neurology

Every 40 seconds, someone somewhere in the United States will have a stroke – and 80-85 percent of those will be ischemic stroke.

Ischemic stroke (pronounced ih-SKEE-mick) is caused by an artery blockage or narrowing that impairs blood flow going to a part, often one side, of the brain. This leads to brain cell injury and causes sudden limb or face weakness, loss of sensation, balance, vision or ability to speak/understand. Stroke symptoms are easily remembered with the mnemonic BE-FAST (Balance loss, Eye – visual loss, Face weakness, Arm or leg weakness, Speech/language impairment, T – time, act immediately by calling 911). If left untreated, a stroke can result in permanent disability or death.

However, there are factors that predict an increased risk of stroke – one of which is a history of transient ischemic attack (TIA), also known as a stroke warning. Like ischemic stroke, TIAs are caused by an interruption of blood flow to a portion of the brain caused by a narrowing of the vessels or a small blood clot. Unlike ischemic stroke, the effects of TIA can be milder and generally last no more than minutes to an hour.

Here are some more ways to tell the difference between a TIA and Ischemic Stroke:

	Transient Ischemic Attack	Ischemic Stroke
Symptoms	Numbness or weakness in your face or limbs, usually on one side of the body. Slurred speech or difficulty speaking. Blurred or double vision. Sudden, severe headache.	Weakness or paralysis in your face or limbs, usually on one side of the body. Slurred speech or difficulty speaking; confusion. Blackened, blurred or double vision. Dizziness, loss of coordination or difficulty walking. Sudden, severe headache.
Symptom Duration	Less than an hour.	Permanent; get progressively worse until treatment is received.
Treatment	Seek medical attention immediately. Symptoms go away on their own, but it’s important to find and treat the root cause.	Seek medical attention immediately. Therapies or interventions may include: Intravenous injections Endovascular procedures Neck surgery
Effects	Not fatal, but put you at increased risk for stroke.	Temporary or permanent disability; death. Increases your risk for future strokes.

Without any permanent effects, it may be tempting to shrug off a transient ischemic attack, but to do so may put your life at risk. A study published in the American Family Physician journal found that 5-10 percent of patients presenting with TIA will have a full ischemic stroke within a week. That’s why it’s so important that you seek immediate medical attention if you think you’ve had a transient ischemic attack. Once admitted, physicians will confirm a transient ischemic attack diagnosis, assess your immediate stroke risk and determine the cause of the TIA.

If the TIA was caused by a severe narrowing in the carotid artery (the largest front artery in your neck), the doctor may recommend a carotid endarterectomy to surgically remove plaque buildup, or an angioplasty and stent procedure. The former is the open surgical removal of the plaque that’s restricting blood flow, while the latter involves inflating a tiny balloon delivered within a small catheter inserted in the groin to widen the narrowed point of the diseased neck artery followed by placement of a cylindrical stent to keep the artery segment open.

After discharge for transient ischemic attack, even after receiving treatment, you’re still at increased risk for stroke. Your doctor will likely prescribe one or more blood thinners to prevent clotting, and cholesterol lowering medication to prevent inflammatory and cholesterol-associated blood vessel wall disease. In addition, it’s going to take some lifestyle modifications, such as quitting smoking, reducing heavy alcohol consumption, getting more exercise and maintaining a healthy body weight, as well as optimal management of existing conditions like high blood pressure and diabetes, to significantly reduce your overall stroke risk.

Each month, the Stroke Program at Washington Hospital treats approximately 40 patients who have had various types of cerebrovascular events – an estimated 80 percent of which are preventable. Knowing the signs of transient ischemic attack and/or stroke, (BE-FAST) can help save your life, the life of a loved one, or the life of the person next to you.

Posted May, 2019

About Jack C. Rose, MD
Dr. Rose is an expert in neurointensive care and cerebrovascular disease and was among the first 100 physicians in the world to become Board Certified in Neurocritical Care. He is also Board Certified in Neurology as well as Vascular Neurology by the American Board of Psychiatry & Neurology. Dr. Rose’s experience and leadership augments Washington Hospital’s comprehensive stroke and neurosurgical programs, especially in cerebrovascular neurosurgery and interventional neuroradiology. He provides patients treated at Washington Hospital with the continuity of care that is critical when treating the full range of cerebrovascular conditions.

Dr. Rose obtained his undergraduate degree at Stanford and his medical degree at Columbia University’s College of Physicians and Surgeons. He did his medical internship at Columbia University and his neurology residency at the Neurological Institute of New York/New York Presbyterian Hospital. Dr. Rose completed his fellowship in stroke and neurocritical care at the University of California, San Francisco.

The philosophy of care that guides Dr. Rose’s clinical practice focuses on the rapid and accurate identification of patient’s acute brain injuries and state-of-the-art medical and neurosurgical treatments. He is dedicated to educating his patients, family members and other health care providers about the specific disease, neurological deficits and complications that are being faced by his patients and their recommended treatments. Dr. Rose feels that healthcare education & research, honest clinical discussions and becoming familiar with the patient and their family & friends are equally as rewarding as being able to help restore a patient’s injured brain to its most optimal state possible.