Dallas - Stroke symptoms that disappear in under an hour, known as a transient ischemic attack (TIA), need emergency assessment to help prevent a full-blown stroke, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke. The statement offers a standardized approach to evaluating people with suspected TIA, with guidance specifically for hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.
TIA is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the U.S. experience a TIA, although this estimate may represent underreporting of TIA because symptoms tend to go away within an hour. While the TIA itself doesn’t cause permanent damage, nearly 1 in 5 of those who have a TIA will have a full-blown stroke within three months after the TIA, almost half of which will happen within two days. For this reason, a TIA is more accurately described as a warning stroke rather than a “mini-stroke,” as it’s often called.
TIA symptoms are the same as stroke symptoms, only temporary. They begin suddenly and may have any or all of these characteristics:
- Symptoms begin strong then fade;
- Symptoms typically last less than an hour;
- Facial droop;
- Weakness on one side of the body;
- Numbness on one side of the body;
- Trouble finding the right words/slurred speech; or
- Dizziness, vision loss or trouble walking.
The F.A.S.T. acronym for stroke symptoms can be used to identify a TIA: F ― Face drooping or numbness; A ― Arm weakness; S ― Speech difficulty; T ― Time to call 9-1-1, even if the symptoms go away.
“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, M.D., chair of the scientific statement writing committee and associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “There also is variability across the country in the workup that TIA patients may receive. This may be due to geographic factors, limited resources at health care centers or varying levels of comfort and experience among medical professionals.”
For example, Amin said, “Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation that they would at a certified stroke center. This statement was written with those emergency room physicians or internists in mind – professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging evaluation and treatment decisions.”
The statement also includes guidance to help health care professionals tell the difference between a TIA and a “TIA mimic” – a condition that shares some signs with TIA but is due to other medical conditions such as low blood sugar, a seizure or a migraine. Symptoms of a TIA mimic tend to spread to other parts of the body and build in intensity over time.
Who is at risk for a TIA?
People with cardiovascular risk factors, such as high blood pressure, diabetes, obesity, high cholesterol and smoking, are at high risk for stroke and TIA. Other conditions that increase risk of a TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea and coronary artery disease. In addition, a person who has had a prior stroke is at high risk for TIA.
Which tests come first once in the emergency room?
After assessing for symptoms and medical history, imaging of the blood vessels in the head and neck is an important first assessment. A non-contrast head CT should be done initially in the emergency department to rule out intracerebral hemorrhage and TIA mimics. CT angiography may be done as well to look for signs of narrowing in the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowing of the large arteries that lead to the brain.
A magnetic resonance imaging (MRI) scan is the preferred way to rule out brain injury (i.e., a stroke), ideally done within 24 hours of when symptoms began. About 40% of patients presenting in the ER with TIA symptoms will actually be diagnosed with a stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner, and they may admit the patient to the hospital for MRI or transfer them to a center with rapid access to one.
Blood work should be completed in the emergency department to rule out other conditions that may cause TIA-like symptoms, such as low blood sugar or infection, and to check for cardiovascular risk factors like diabetes and high cholesterol.
Once TIA is diagnosed, a cardiac work-up is advised due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department, however, it could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having a TIA. An electrocardiogram to assess heart rhythm is suggested to screen for atrial fibrillation, which is detected in up to 7% of people with a stroke or TIA. The American Heart Association recommends that long-term heart monitoring within six months of a TIA is reasonable if the initial evaluation suggests a heart rhythm-related issue as the cause of a TIA or stroke.
Early neurology consultation, either in-person or via telemedicine, is associated with lower death rates after a TIA. If consultation isn’t possible during the emergency visit, the statement suggests following up with a neurologist ideally within 48 hours but not longer than one week after a TIA, given the high risk of stroke in the days after a TIA. The statement cites research that about 43% of people who had an ischemic stroke (caused by a blood clot) had a TIA within the week before their stroke.
Assessing stroke risk after TIA
A rapid way to assess a patient’s risk of future stroke after TIA is the 7-point ABCD2 score, which stratifies patients into low, medium and high risk based on Age, Blood pressure, Clinical features (symptoms), Duration of symptoms (less than or greater than 60 minutes) and Diabetes. A score of 0-3 indicates low risk, 4-5 is moderate risk and 6-7 is high risk. Patients with moderate to high ABCD2 scores may be considered for hospitalization.
Collaboration among emergency room professionals, neurologists and primary care professionals is critical to ensure the patient receives a comprehensive evaluation and a well-communicated outpatient plan for future stroke prevention at discharge.
“Incorporating these steps for people with suspected TIA may help identify which patients would benefit from hospital admission, versus those who might be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke.”
The recycle bins are for use only by Village of Philo and Philo Township residents. They request residents not to bring your recycling from the offices and business from Champaign-Urbana or surrounding communities for recycling.
If the bins are full, do not leave items on the ground around or next to them. This is considered illegal dumping.
To make as much space as possible in the bins, the Village asks that all boxes be broke down or crushed. Tearing apart cardboard boxes helps to create additional space so more residents can use the bins.
Finally, users should make sure the bin doors are closed after all items have been deposited. Again, nothing should be left outside of the bins that includes plastic swimming pools, large pieces of metal, and items too large to fit into the available space in the bin.
Residents must place only approved items in the bins. Acceptable items for recycling includes: newspapers, books, paper & magazines, cardboard boxes, tin cans, aluminum cans, glass bottles & jars, and plastics (PETE, HDPE 1 or 2). Please bag loose items in plastic bags like newspapers or paper products. Cardboard should be broken and folded down as much as possible.
Items not allowed in the bins include: televisions, computers, car batteries, motor oil, and any liquids or paint products.
A retired minister and his wife had never owned a house. They had spent all their married lives living in housing provided by churches. At age 65, they bought a house and financed it for 15 years. They had been frugal and had saved a good down payment. They paid for the house by age 80. The value of the house increased over the years and at age 83 they sold the house and received a very nice check. The money from the sale was enough to help them fund their next ten years in a nice assisted living apartment. While taking on a mortgage at 65 appeared crazy to some it afforded them financial security further down the road.
Many years ago, I bought a modest new house that cost $151,000. I barely scraped together the nearly $30,000 down payment. The house was financed for 15 years. I began the laborious journey of writing a monthly check to the bank. After about eight years, I needed money to pay medical bills and was able to borrow $30,000 against my equity. It was nice that I had the equity because at that time I really needed the cash. Looking back, I would never do that again because it made the actual cost of my house increase to $181,000. For a couple of years, I had two payments to make to the bank. A couple of years later my wife passed. If I had needed to borrow $10,000 against my house, I could have done so to pay for funeral expenses. Fortunately, we had both taken out small insurance policies that covered that cost. Eventually I refinanced and consolidated the mortgages. By the grace of God I still paid for the house in 15 years.
I don’t like monthly payments or paying rent. For most of us, at some point in our lives there will be a monthly payment of some kind. I’ve lived in apartments on several occasions and even houses furnished to me by congregations I served. I didn’t care for either one. I’m not saying I wouldn’t do it again but my preference is to live in a place that is actually mine for as long as possible.
Renting a house or an apartment works for many at different stages of life. Buying a house is tough because it is a major financial commitment. You normally have to come up with 20% of the price to pay down as well as have the income to make the payments. That’s not always easy.
New houses in a nearby neighborhood are presently selling for $400,000. Most of them are modest three to four-bedroom houses. Having enough money to make the down payment and monthly payments is a lot for any person or family.
However, rent is expensive. Depending on where you live you may be paying $800 to $3,000 a month for a small apartment. You don’t have maintenance or property taxes but you’ll also never see that money again. A friend of mine sold her house at age 70 and moved into an apartment complex for people over age 55. She pays rent but she says the landlord treats her well and is timely with upkeep. A landlord who is very untimely with upkeep is very frustrating.
There are pros and cons to owning and renting. Choosing depends on your situation and personal preferences. A landlord can raise your rent and have rules pertaining to pets, painting, and more. However, it may be just exactly what you need. Typically, you don’t want to sink your money into property if you are going to move in three or four years. You might come out ahead if you buy a fixer upper and have the time and money to improve the property. You don’t want to make a bad buy. Buying property that you can’t resell is a bad idea, unless you love it and plan to live there a long time.
Keep in mind that a big chunk of most American’s wealth is in the house they own. If you pay for it and maintain it you can normally sell it to someone and recoup a lot of your money. You might even make a nice profit.
TOLONO - Unity Junior High School announced the 8th grade recipients achieving Honor Roll and High Honor Roll status for their academic performance during the second quarter two weeks ago. Congratulations to all the students who earned the requisite grade point average to celebrate the honor.
"These talented students have worked long and hard to prepare this wonderful music, and we would all be gratified to see you in the audience," said Kevin Kelly, Music Director
for youth orchestra.
The program includes two popular Russian pieces from Shostakovich and Tchaikovsky, as well as works from American composers Aaron Coplan, Irving Fine, Virgil Thomson, and John Philip Sousa.
Admission to the event is free to the public and begins promptly at 7 p.m. Smith Memorial Hall is located on the University of Illinois campus at 805 S. Mathews Avenue.