MEDICAL MINUTE: CHESS PAINS
A few weeks ago, I brought a chess board to my office. Our department sees faculty members working long hours each week with frequent night classes making a need for a diversion crucial to prevent fatigue. I’ve found chess to be a great stress relief from the pressures of working with our health care students, but I would be lying if I said that I always won. In fact, I seldom win. My director is an extremely challenging opponent, and I don’t say that just because he’s my boss. Recently, he had me backed into a corner on the chess board, but somehow, I kept wiggling out of his trap. At one point, he looked at me and said, “You’re going to lose. Do you enjoy living on borrowed time?” This got me thinking about Transient Ischemic Attacks (TIAs), or mini-strokes, and how these often these individuals are, without intervention, living on borrowed time.
If you are a long-time reader, you no doubt remember that we talked about general strokes some time back. We can divide them into two basic categories: hemorrhagic and occlusive. The hemorrhagic stroke is a result of a burst vessel inside the brain and typically does not lead to TIAs. Occlusive strokes, on the other hand, result from either a clot that makes it way to the brain or the formation of plaque inside the arteries that limits the amount of blood that passes through. The only difference between a TIA and Cerebral Vascular Accident (CVA), or full stroke, is that the symptoms of a TIA resolve itself within a few hours. It is, as the name implies, a temporary interruption of blood movement throughout the brain with no permanent damages.
What does a person look like when they are having a stroke? There are many different stroke scales that a healthcare provider might use, but there is also a great, simple acronym for the layperson: F.A.S.T. F stands for face drooping, A is for arm weakness, S is for speech difficulty, and T means that it is time to call 911. I cannot agree with “T” more! The simple truth is that there is no way to tell the difference between a TIA and a CVA until the symptoms clear. Waiting for that to happen makes as much sense as waiting to call the fire department about a brush fire to see if it endangers your house first. If you wait to see if there is any real danger, it will be too late! We have a saying in the medical field: ‘Time is Brain.’ There is a very small window in which clot-busting medications can be administered for an occlusive stroke. Typically, this is around 3-4 hours. Before I go any further, remember to call 911 as soon as you begin to notice symptoms described above.
So why do some clots dissolve and become TIAs while others do not and form massive CVAs? First, the body has naturally occurring agents that are dispatched to bust clots as soon as they are detected. Eventually, all clots will dissolve, but the time in between the dissolving and the size of the clot itself can lead to permanent damage from lack of oxygen to certain regions of the brain. As mentioned above, there is no way to tell if a clot will dissolve on its own, so time is of the essence. Also, you should know that the vast majority of strokes are not preceded by a TIA. However, the TIA is a dire warning sign. Almost a third of the patients that experience a TIA will go on to have a major stroke within a year. That number jumps to 50% within two years. The key is to get to a hospital, even if symptoms have resolved, to determine if a TIA has occurred. From there, your physician can recommend treatments-whether it is medication or surgery- to prevent another stroke from occurring.
Have you had stroke-like symptoms that only lasted for a short time? The website stroke.org has a stroke risk calculator that can help you understand your risk for stroke and TIAs. Also, talk with your doctor about changes to your diet, social habits, and medications that can influence the likelihood of you having a stroke. In either case, do not ignore the warning signs of a stroke. Remember, waiting to see if symptoms resolve themselves is a dangerous game that you don’t want to play. Just like my doomed chess match, not taking action can force you into living on borrowed time. Stay safe out there.
M. Eric Williams, MS, NR-P is a syndicated columnist and the Assistant Director of Emergency Medical Technology Education at Jones County Junior College. He is a current Doctoral researcher at Delta State University and has 15 years’ experience in healthcare. If you have questions or comments, you may contact him at eric.williams@jcjc.edu
