Silent and Deadly

By Ian K. Smith, MD

This past week researchers from around the world gathered for the American Stroke Association's 25th International Stroke Conference in New Orleans to discuss better ways of dealing with strokes. The news out of the meeting was not good. According to a new study, the number of strokes--having declined in the 1960s and '70s--is unexpectedly rising again. In 1999 alone there were 750,000 full-fledged strokes in the U.S. and half a million transient ischemic attacks (TIAS), or ministrokes. Although both numbers have doctors worried, the conference paid particular attention to the ministrokes because of both the stealth of their damage and the dramatic effectiveness of timely treatment.

Ministrokes result from temporary interruptions of blood flow to the brain. Unlike full strokes, they present symptoms lasting anywhere from a few seconds to 24 hours. Rarely do they cause permanent neurological damage, but they are often precursors of a major stroke.

"Our message is quite clear," says Dr. Robert Adams, professor of neurology at the Medical College of Georgia in Augusta, the conference moderator. "TIAS, while less severe than strokes in the short term, are quite dangerous and need a quick diagnosis and treatment as well as appropriate follow-up to prevent future injury."

Unfortunately, ministrokes are greatly underdiagnosed. A study conducted for the National Stroke Association indicates that 2.5% of all adults age 18 or over (about 4.9 million people in the U.S.) have experienced a confirmed TIA. An additional 1.2 million Americans over the age of 45, the study showed, have most likely suffered a ministroke without realizing it. These findings suggest that if the public knew how to spot the symptoms of stroke, especially ministrokes, and sought prompt medical treatment, thousands of lives could be saved and major disability could be avoided.

The problem is that the symptoms of a ministroke are often subtle and passing. Nonetheless, there are signs you can look out for:

--Numbness or weakness in the face, arm or leg, especially on one side of the body.

--Trouble seeing in one or both eyes.

--Confusion and difficulty speaking or understanding.

--Difficulty walking, dizziness or loss of coordination.

--Severe headache with no known cause.

Along with these symptoms, researchers have identified some key indicators that increase your chances of having a full-blown stroke after a TIA: if you're over 60, have experienced symptoms lasting longer than 10 minutes, feel weak and have a history of diabetes.

As with many diseases, you can help yourself by changing your lifestyle. The first things you should do are quit smoking, limit your intake of alcohol to no more than a drink or two a day and increase your physical activity. Even those who suffer from high blood pressure or diabetes can improve their odds--and minimize complications if they do have a stroke--by keeping their illness under control.

If you experience any of the symptoms, your first call should be to your doctor. It could be the call that saves your life.

For more information about strokes, visit americanheart.org You can reach Dr. Ian by e-mail at ianmedical@aol.com