The minister may have grave consequences

Kristin Kramer woke up early on Tuesday morning 10 years ago, because one of her dogs had to leave. Then a few strange things happened.

When she tried to call the second dog: “I couldn’t speak,” she said. When he went downstairs to let them into the yard: “I noticed that my right hand was not working.”

But she returned to bed, “which was completely stupid,” said Mrs. Kramer, currently 54, office manager in Munk, ind. “He did not register that something great happened”, especially since an hour later “I come back an hour.”

So “she just blown out” and went to work.

This is a common response to neurological symptoms that signal TIA, a short-lived ischemic attack or a ministrus. At least 240,000 Americans experience one year during occurrence Growing up with age.

Because the symptoms disappear quickly, usually within a few minutes, people do not look for immediate treatment, causing their high risk of greater stroke.

Mrs. Kramer felt the tingling of her arms for the next few days and saw her doctor who found nothing disturbing on the CT scan. But then she began to “shake” her words and finally a relative led her to the ambulance.

Until then, she couldn’t sign her name. After MRI, she remembered: “My doctor came in and said,” You had a little stroke. “

Were these early aberrations TIA? Did 911 combination and earlier start of anti -cramping drugs prevent its stroke? “We don’t know,” said Kramer. Now she is doing well, but she stood again in the face of such symptoms: “I would seek medical aid.”

Now a vast epidemiological study conducted by scientists from the University of Alabama in Birmingham, published in Jama Neurology, indicates another The reason to take tias seriously: Within five years, the results of research participants on cognitive tests after TIA falls as violently as among the victims of full stroke.

“If you have one stroke or one TIA, without any other event in time and no other change in the medical condition, the cognitive inheritance indicator is the same,” said Dr. Victor del Bene, a neuropsychologist and main author of the study.

Some Accompanying the editorial article Dr. Eric Smith, a neurologist at the University of Calgary, was clearly entitled “A short-lived ischemic attack – it is not so transient!”

The study showed that even if the symptoms disappear-firmly within 15 minutes to an hour-tias set people on a different cognitive slope in later life, Dr. Smith said in an interview: “a long change in the cognitive ability of people, probably leading to dementia.”

The study, analyzing the results of data on over 30,000 participants, followed three groups of adults over 45 years venerable, without the history of stroke or TIA “It was a complex group to examine, because you lack the basic lines about how they function before TIA or stroke,” said Dr. del Bene.

However, in this longitudinal study, scientists could separate those who had TIA from a group that felt a stroke, as well as from an asymptomatic control group. The team adapted their findings for many demographic variables and health conditions.

Immediately after Tia “we don’t see a sudden change of cognition”, measured by cognitive tests carried out every other year, said Dr. del Bene. A group of strokes showed a pointed decline, but the participants of the TIA group and the control group “were more or less the neck and neck”.

Five years later, the photo was different. People who experienced TIA were better cognitively than those who had hit. But both groups experienced cognitive fall and equally violent.

After taking into account various possible causes, scientists came to the conclusion that the cognitive decline reflects not demographic factors, chronic diseases or normal aging, but TIA herself.

“This is not dementia,” said Dr. del Bene about the fall after “Tia” may not even be a gentle cognitive impairment. But this is a changed trajectory. “

Of course, most older adults have different diseases and risk factors, such as heart disease, diabetes or smoking. “These things together work synergistically to raise the risk of cognitive fall and dementia with time,” he said.

Discoveries strengthen long fears that people experiencing TIA do not react quickly enough. “These events are grave, pointed and threatening,” said Dr. Claiborne Johnston, neurologist and medical director of Harbor Health at Austin.

After TIA, neurologists took the risk of another stroke within 90 days at 5 to 20 percent, and half of this risk occurs during the first 48 hours.

“Returning to normal does not mean that you can ignore or delay it and discuss it with your primary care doctor during the next visit,” said Dr. Johnston. Symptoms should cause a 911 phone and an ambulance assessment.

How to recognize TIA? Dr. Tracy Madsen, an epidemiologist and specialist of emergency medicine at the University of Vermont, promotes a quick acronym: loss of balance, vision changes, face fall, arm weakening, problems with speech. T is time because don’t waste.

“We know much more about how to prevent stroke, if people reach the hospital,” said Dr. Madsen, vice president of the American Heart Association committee, which in 2023. Changed recommendations for Tias

The statement required more comprehensive and aggressive tests and treatment, including imaging, risk assessment, anti -glotting and other drugs, and counseling on lifestyle changes that reduce the risk of stroke.

Unlike other urgent conditions, TIA may not look dramatic or even observable; Patients themselves have to learn how to react.

Karen Howze, 74, a retired lawyer and journalist in Reno in Nev.

Perhaps the “short-lived ischemic attack” is too calming the label, Dr. Johnston and co -author argued Editors 2022 in the cavity. They suggested that giving TIA a more terrifying name, such as “compact ischemic stroke”, more likely that it would cause a 911 phone.

Experts conducted interviews for this column, everyone supported the idea of ​​the name, which contains the word “stroke”.

The change in medical practice is “frustrating slowly”, admitted Dr. Johnston. But regardless of the nomenclature, remembering this can lead to more examples, such as Wanda Mercer, who shared her experience in the previous column.

In 2018, she donated to Bloodmobile in front of her office in Austin, where she was the administrator of the systems at the University of Texas, and then went to lunch for two blocks to the restaurant. “Waiting in the queue, I remember that I felt a bit damaged,” she said. “I woke up on the floor.”

By reviving, she assured a worried manager that she just fainted after giving blood. But the manager already called an ambulance – it was an knowledgeable movement No. 1.

ER doctors conducted tests, did not see problems, gave Dr. Mercer intravenous flowers and wrote it out. “I started telling my colleagues:” Guess what happened to me in lunch! ” – she remembered. But she said, she lost the words: “I couldn’t express what I wanted to say.”

Sharp Move No. 2: Collaborators, Suspecting the strokecalled EMT for the second time. “I didn’t want to go,” said Dr. Mercer. “But they were right.” This time, ambulance doctors diagnosed a compact stroke.

Dr. Mercer had no relapses. Every day he takes a statin and aspirin for a child and sees a primary care physician every year. Otherwise, at the age of 73, she retired to vigorous travel life, Picklescall, running, weightlifting and book groups.

“I am very grateful,” she said “that I have a joyful story to tell.”