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tPa Clot-Busting

When a blood vessel in the brain becomes blocked, time is critical. Called a stroke, this blockage means part of the brain may not be getting the oxygen and nutrients it needs. If treatment is delayed, parts of the brain may die. Patients may then experience certain symptoms, such as slurred speech or the inability to move arms or legs. That means if a patient puts off going to the hospital when experiencing stroke symptoms, it could affect recovery.

Patients who don’t get to the hospital within 90 minutes of stroke symptoms starting may not be eligible to receive an effective “clot-busting” drug called tPA. tPA quickly dissolves the clots that cause many strokes. By opening a blocked blood vessel and restoring blood flow, tPA can reduce the amount of damage to the brain that can occur during a stroke.

“To be effective, tPA and other drugs like it must be given within a few hours of the stroke symptoms beginning,” explains Tessy Jenkins, M.D. “Because of this timeline, it is extremely important that patients who think they may be having a stroke go to the nearest emergency room immediately. A delay can mean they are not eligible for clot-dissolving drugs that can mean the difference between survival and death, or between complete recovery and severe disability.”

tPA benefits and risks

Clot-dissolving drugs are not for everyone and the stroke team at Sinai-Grace is trained to quickly identify those patients who are the best candidates.

Because tPA increases the risk of bleeding, patients who have a history of bleeding problems, recent surgery or trauma, uncontrolled high blood pressure or recent head injury may not be able to receive it. Some strokes are caused by a ruptured blood vessel, not a blocked blood vessel, so a CT scan is used to rule out these types of strokes.

“While the risks of tPA should be considered, the benefits of prompt treatment of the clot far outweigh the risks for most people,” Dr. Jenkins says. “If you or your family is faced with the decision to use tPA, listen carefully to the risks and benefits, but don’t delay your decision.”

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What Is a Mini-Stroke?

You hear the term “stroke” a lot these days. Sometimes people say they had a “mini-stroke” or “TIA.” You may be wondering, what exactly do these different labels mean, and which ones should we be concerned about? Here’s what you need to know.

TIA or Transient Ischemic Attack is defined by the American Stroke Association as “a temporary blockage of blood flow to the brain.” TIAs do not typically result in permanent damage. However, they can be serious and should not be ignored, as they can indicate that a full-blown stroke is ahead. A TIA is often referred to as a “mini-stroke,” but a better term is “warning stroke.”

What are the symptoms of a TIA? Actually, stroke and TIA symptoms can vary widely depending on the part of the brain that is affected. Also, other neurological disruptions, such as migraines, minor seizures and low blood sugar can mimic TIA symptoms. The primary distinguishing feature of a TIA or stroke is that it stems from decreased blood flow located in one particular blood vessel in the brain. Therefore, the effects tend to be associated with a specific brain function, such as speech, vision,  sudden isolated weakness, numbness, or drooping on one side of the body or face.

How are TIAs diagnosed and treated? To determine if a TIA or stroke has occurred, it’s important to be evaluated immediately by a doctor at a hospital emergency room or neurology department. Knowing the timing, duration and specific physical details of your experience will be helpful to the doctor.

Tests, such as CT scans or MRI scans, may be performed to help identify a brain injury or an area where blood flow has been compromised. The goal of TIA treatment is to prevent a full-fledged stroke. Depending on the extent of the blockage, doctors may prescribe a clot-dissolving drug. If one of the carotid arteries is significantly narrowed, a procedure to decrease the blockage may be recommended to help prevent future TIAs or strokes.

How is a stroke treated?  If it is determined that the event is a stroke, anti-clotting medications and drugs to lower blood pressure and cholesterol may be part of the ongoing treatment. At the first indication of a stroke, getting treatment within three hours is vital for improving long-term outcomes and reducing the risk of permanent disability.

What are the risk factors for TIAs? People who have TIAs often have other cardiovascular risk factors. These can include:

  • Being middle-aged or older
  • Having diabetes
  • Having high blood pressure
  • Abnormal cholesterol
  • Being a smoker
  • Those who get little or no exercise

What can help prevent TIAs and stroke? You’ve heard it before, but these behaviors can help prevent or lower the risks of many health issues, including stroke:

  • Eating a healthy diet, rich with fruits and vegetables and low in saturated fats.
  • Getting regular exercise
  • Not smoking