A fifty-year-old lady was alone at home when she suddenly developed difficulty speaking. A neighbour rushed her to the hospital and her family was informed, who were shocked to know about this condition. But within a few hours, while under surveillance, she recovered spontaneously. The doctor explained that she had suffered from a Transient Ischemic Attack (TIA) in short. TIA (mini-stroke) is a sudden neurological deficit that improves within 24-72 hours, hence is transient. It can occur at any age, but the probability increases with increasing age. Both genders can be affected, but women are more affected after menopause because the feminising hormones that protect them from hypertension and cardiovascular problems are reduced in the body. Here, the blood supply to part of the brain is cut off due to the occlusion of a blood vessel, leading to paralysis of the affected part. The occluding clot may dissolve or dislodge, or the surrounding blood vessels may re-perfuse the affected area of the brain. Due to this, the paralysis recovers spontaneously in less than 24 hours. The risk factors for developing TIA are the same as those for a major stroke. Obesity, increased blood lipid levels, high blood pressure, diabetes, alcohol, tobacco, and stress are all risk factors for TIA. In the case of a hyperactive thyroid gland affecting the heart, or irregular beating of the heart due to any cause, a small clot can break off from the heart and pass through the bloodstream to the brain, occluding a blood vessel. At times, there may be clot formation in the lower limbs due to prolonged recumbence. Part of this clot may detach and reach the brain, causing paralysis of the affected part. Cervical spondylosis can also cause TIA because the small new bones formed in the neck can occlude vessels supplying blood to the brain. Whatever the cause may be, a TIA is very frightening for the patient and their close ones alike. But it always improves within 24 hours. The severity of paralysis depends on the part of the brain affected. There may be sudden blindness, paralysis of one or more limbs, loss of sensation, dizziness, and sudden unconsciousness, etc. Symptoms may be completely reversed. Diagnosis of TIA is easily made by the history of sudden neurological deficit which improves by itself. It is also important to differentiate it from sudden, temporary unconsciousness caused by electrolyte imbalance, low blood glucose levels, infections such as cerebral malaria and encephalopathy, etc. conditions. Relevant laboratory tests aid in diagnosing these conditions. C.T. scan helps to confirm the diagnosis of TIA. At this juncture, it is important to assess the risk factors and ensure that the patient tries to prevent a repeat episode of TIA. If risk factors persist, an individual may experience recurrent attacks of a mini-stroke, which may progress to a fully developed stroke that does not resolve easily. If TIA turns into a stroke, the patient may be left with long-lasting paralysis which may or may not improve. Mostly, some sequelae may remain, causing permanent disability. A healthy, fat-free diet, regular physical exercise, mental relaxation, avoidance of smoking and alcohol, and good control of hypertension and diabetes are some measures that can minimise the chances of having a TIA. Those suffering from cervical spondylosis should avoid bending their necks and do regular exercises to prevent exacerbation of spondylosis and the development of TIA. Anyone who has been bedridden for a long time due to sickness or disability should be encouraged to move their legs on the bed in order to prevent clot formation. After the development of a TIA, medicines are given to dissolve the clot present in the brain and prevent further clot formation. Dr Rachna Pande is a specialist in internal medicine.
