TIAs are warning shots of a future stroke

TIAs are warning shots of a future stroke; one out five of those who have just suffered a temporary ischemic attack may have a full-blown episode within three months; and half of them will be observed inside of two days.

Time clearly is of the essence; a diagnosis must be made and action taken.

F.A.S.T.

The same FAST acronym is used to diagnose a TIA as a stroke, even if the symptoms resolve in less than an hour.

• F -  Facial drooping
• A - Arm weakness
• S - Speech difficulties
• T - Time to call for an ambulance
  

TIA mimics

There are certain conditions that will mimic a TIA. It's important to be able to tell the difference. Examples would be a history of migraines and epilepsy.

In a wealthy society a CT is initially ordered, followed by an MRI of the brain.

ABCD2 score for suspected TIA

The burning question is whether the TIA is likely to progress to a full-blown stroke. The ABCD² score gives one some inkling of the future.

• A - Age > 60
• B - BP > 140/90
• C - Clinical features, unilateral weakness and speech disturbance
• D¹ - Duration > 1 hour
• D² - Diabetes

• ABCD² TIA calculator^[2]
  

Diabetes

It is obviously very significant that diabetes is the only disease mentioned in the ABCD² score; by pushing one into the "high" rating, it doubles the risk of having a full-blown stroke.

For those concerned about the prevention of a stroke, BP and blood glucose levels are paramount; the two most difficult areas to achieve patient compliance. In particular it means cessation of smoking and weight loss. 

My personal belief is that it is the clinician's responsibility to point these out very firmly once; and then keep silent unless asked for guidance. Nagging achieves nothing; but no patient who has a major stroke should ever be able to say that no doctor ever made these matters absolutely clear.

For centuries orange and yellow foods have been used in the management of diabetes. The known active agents involved in lowering blood glucose are nicotinic acid and trigonelline.

Pumpkin for diabetes makes interesting reading for those concerned with both prevention and treatment.

From the horse's mouth

Food as medicine

Interestingly there is strong evidence that dark-green leafy vegetables, and particularly the stalks are rich in the nitrates that lower blood pressure.

Vegetables like spinach, kale and broccoli should daily be on the menu; it is not necessary to devein young leaves.

Other researchers have proved that just by using food as medicine, without any drugs almost all those suffering from T2DM can put their disease completely into remission; obviously becoming more active is imperative too; and especially taking short walks after starchy meals.

TIAs are warning shots of a future stroke

TIAs are warning shots of a future stroke often within days.

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