When I had a hemorrhagic stroke in 2009, an artery which burst throwing blood every which way into the brain, there was somebody with me who saw me convulsing at 4am. Otherwise, if I’d been alone, I’d already be long gone and 6 feet under. The person called the ambulance and rest was missed history for a week while I was unconscious.
I missed the helicopter ride while I was “out,” but I woke up after a week as the copter landed at New Jersey’s Capital Health, an acute hospital specializing in stroke recovery. My younger son’s soft strumming on his acoustic guitar and sitting on my bed, and the older one sitting in a nearby chair, waiting for me to open my eyes, are nostalgic memories. For that, I’m grateful but sad with what I put my sons through.
The stroke I had was full-flegded. But when people use the term “ministroke,” they’re referring to a Transient Ischemic Attack (TIA).
AÂ TIA is a partial blockage of blood flow to part of the brain, spinal cord or the thin layer of tissue at the back of the eye known as the retina. This blockage may cause temporary stroke-like symptoms, but a TIA doesn’t damage brain cells or cause permanent disability.Â
Also, a TIA is often an early warning sign that a person is at risk of a stroke. About 1 in 3 people who has a TIA goes on to experience a stroke. The risk of stroke is especially high within 48 hours of a TIA.
The symptoms of a TIA are similar to those of a stroke and include:
- Numbness or muscle weakness, usually on one side of the body
- Trouble speaking or understanding speech
- Dizziness or loss of balance
- Double vision or trouble seeing in one or both eyes
Symptoms of TIA usually last only a few minutes, but they may persist for up to 24 hours. Since the symptoms of TIA and stroke are the same, it’s important to seek medical attention right away.
Depending on the underlying cause, you may need medicine to prevent blood clots. Or you may need a procedure to remove fatty deposits, known as plaque, from the arteries that supply blood to your brain. This procedure is called a carotid endarterectomy for severe carotid artery disease. After cutting along the front of the neck, a surgeon opens the blocked carotid artery and removes the plaque, using stitches or a graft to repair the artery.
Carotid arteries are located on each side of the neck, just below the jaw line. They supply blood to front of the brain where sensory and motor function as well as speech, vision, personality and thinking reside. Two smaller arteries — the vertebral arteries — supply blood to the back of the brain, the cerebellum and brainstem.
Carotid stenosis, also known as carotid artery disease, is a narrowing of a carotid artery. The narrowing is caused by plaque or fatty deposits along the inner wall of the artery resulting in reduced blood flow to the brain and, in some cases, a complete blockage of the artery.
These symptoms are often a sign of a more serious cerebral accident and must be treated immediately to prevent a major stroke. Besides the observable symptoms mentioned above, there are four imaging studies that are used to diagnose carotid stenosis. They are:
- Carotid ultrasound: A noninvasive test that uses ultrasound to create an image of the artery when narrowing of the carotid arteries due to plaque buildup is suspected. It is often the first test used on a patient being evaluated for surgery to reopen a blocked artery. Duplex scanning is a technique that measures blood flow at many points in the blood vessel at one time.
- Carotid arteriogram: Arteriography, also known as angiography, is a blood-flow test. Dyes are injected into the blood vessels and an X-ray is taken to produce a picture of the blood flow through the vessels.
- Magnetic imaging angiogram (MRA): MRA uses a magnetic field and radio waves to create detailed computer images of blood vessels and is able to distinguish healthy tissue from diseased tissue.
- Computed tomography angiogram (CTA): During a CTA scan, a special dye is injected into a vein in the arm to highlight the blood vessels and makes them easier to see on the scanned images. The CT scanner uses a thin X-ray beam and advanced computer analysis to create highly detailed images.
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Many patients do not show any symptoms and the stenosis is discovered on a routine medical exam as the physician listens with a stethoscope to the blood flowing through the artery.
Similar to coronary artery disease, a carotid artery also may develop arteriosclerosis, a chronic disease characterized by abnormal hardening of the arterial walls with resulting loss of elasticity on the inside of the artery.
If there are symptoms, they will depend on which carotid artery is involved. Some patients who may experience a TIA are usually characterized by blurred vision or a brief loss of vision in one eye, slurred speech, numbness or weakness on one or both sides of the body, paralysis and loss of consciousness resulting from insufficient blood flow to the brain.
Increased risk factors for carotid stenosis are:
- Smoking
- Elevated cholesterol levels
- Diabetes
- Age (men under 75 years old and women older than 75)
- Family or personal history of coronary artery disease or carotid artery disease
- High blood pressure
- Inactivity or sedentary lifestyle
- Obesity
One of the primary risks associated with carotid stenosis is increased susceptibility for a stroke. No physician can predict with absolute surety whether a patient will suffer a stroke due to the narrowing of the carotid arteries. But the thinking that arteries that contain jagged or unstable plaque are more likely to dislodge, and when they do, restricted blood flow to the brain, causing a stroke.
There are two treatment options for carotid stenosis:
- The first involves making an incision in the neck and micro-surgically removing the plaque within the artery. There is a risk of a stroke during this procedure although that risk is deemed to be very small.
- The second is angioplasty and stenting which is a minimally invasive procedure which does not require an incision in the neck. A catheter (tube) is inserted through a small pinhole in an artery in the groin. The artery is expanded with a balloon and a stent (mesh tube) is put in place to hold the artery open and keep the plaque against the arterial wall. The minimally invasive stent procedure is used in a select group of patients who meet clinical criteria.
With stroke being the third leading cause of death in the United States and carotid stenosis accounting for approximately 50 percent of those deaths, medical intervention at the first suspicion of a stroke is necessary.
If a patient’s artery blockage is less than 50 percent, the risk of surgery or stenting may outweigh the benefits. The physician may treat the blockage with anticoagulant medications, such as aspirin, which prevent clots from forming. Also, the doctor may prescribe lifestyle modifications including no smoking and reducing dietary cholesterol, as well as the use of cholesterol lowering drugs.
With blockages greater than 50 percent, surgery may be the best option. Patients who have had a TIA may also be candidates for surgery. As with any invasive surgery, there are risks and complications that need to be discussed with the physician before agreeing to surgery.
I wish I had a TIA rather than a bonafide stroke. Four months in the acute stroke hospital and more time for various falls might never have happened. But then again, research has shown that “1 in 3 people who has a TIA goes on to experience a stroke. The risk of stroke is especially high within 48 hours of a TIA.”
When I think about it, which I do very frequently, with all the body parts ultimately crammed closely together, I’m surprised that most of us aren’t sick more, with one thing or another. So in closing, be thankful for getting up every morning! True, right?
Hi
I am stroke survivor .It is now 13 years .I would like to state : that the Stroke in itself is life threatening but post stroke ,it is simple way to normalcy:Exercise ,exercise and more exercise . It is been 13 years and persons around me rarely have to give way to me. Except for he 5 fingers of the right hand , which seem to be eternally holding a shot put , every thing else is perfect.I have abt 350-355 days of walking (abt 7 km or 10000 Steps) ,followed by after bath the exercise “Pranayama”.
Slow ,steady and longtermish approach. Voila , the Stroke becomes a Strokeless wonder .
Regds
Ganesh