Little stroke

Published November 4, 2018, 12:05 AM

by Charissa Luci-Atienza & Bernie Cahiles-Magkilat



“So here it is at last, the distinguished thing!” 

Henry James (1843-1916), US author.

quoted in A Backward Glance, ch. 14, Edith Wharton (1934)

(said to have been utteredafter his first stroke)


Dr. Jose Pujalte Jr.
Dr. Jose Pujalte Jr.

The Revised Philippine National Police (PNP) Operational Procedures specifically states that “warning shots are prohibited” (Rule 6.3).  This is in response to the real danger of hitting innocent bystanders.  Instead, they’re supposed to use whistles and megaphones.

Now for the human body, there is a warning shot that is a most welcome jolt.

It’s the mini-stroke (other names: transient ischemic attack, little stroke).

Definition. A transient ischemic attack or TIA is “a temporary disturbance of blood supply to an area of the brain, which results in a sudden, brief decrease in brain function.” (US National Institutes of Health website). The operative word here is “temporary” because if it doesn’t go away within 24 hours or even an hour, that’s no longer a “warning shot” but hot lead in your brain – in a manner of speaking.

Signs & symptoms. Have the presence of mind to note any of the following:

  • Numbness, tingling, any change in sensation.
  • Weakness of the extremities.
  • Garbled or slurred speech.
  • Loss of balance.
  • Lack of coordination.
  • Vertigo (the feeling that the room is moving).
  • Confusion.
  • Eye pain.
  • Facial paralysis.
  • Double vision/loss of vision/decreased vision.

It will really help that a friend or loved one is alert enough to pick up any of those presentations above. But if it is happening to you, you must volunteer the information or ask, for example: “I feel one side of my face has suddenly drooped. Do you see it?” Unless you just got a half-priced face lift for half the face, that may be a TIA.

Causes. But why does a mini-stroke happen? Four plausible reasons: there could be a small blood clot in a brain artery; a blood clot elsewhere can be thrown off and finds its way to the brain; a blood vessel could narrow to a point that blood passing through it is choked and finally, blood vessel injury.  The point to make is that even a brief interruption of blood flow to the brain can cause a decrease in brain function. That is what neurologists (the experts in this condition) would call a neurologic deficit. This is different from a mental deficit which is common in politics and show business (though show business and politics in this country are now increasingly interchangeable). You are at risk for a TIA if you have high blood pressure, heart disease, migraine. Smoking and diabetes too, and advancing age.  Remember that about one third of those patients with TIA will proceed to a full-blown stroke.

Tests. The good doctor will request blood tests to determine if there’s derangement in bleeding time or platelets. The following may also be ordered: a cranial CAT scan, carotid duplex or ultrasound of the main arteries to the brain, an echocardiogram to assess the heart function and a cerebral arteriogram (a special imaging study to delineate the blood vessels of the brain).

Treatment. Blood disorders, if found, can be co-managed with a hematologist or a blood expert. The goal of treatment is to always prevent the onset of a stroke and so adequate arterial supply to the brain must be returned and improved. The cardiologist will manage your hypertension and heart disease while the endocrinologist will see to it that diabetes is controlled. STOP SMOKING. The doctors may also prescribe platelet inhibitors and anti-coagulant medications to reduce the risk of clotting. Aspirin is the cheapest and most commonly used. STOP SMOKING. Finally surgery in the form of carotid endarterectomy may be suggested for some patients.

Many doctors believe that aspirin taken 81mg a day or 100 mg every other day is a stroke preventer. STOP SMOKING. But is there is anything to remember after reading this? Yes: TIA is a MEDICAL EMERGENCY. You must see a doctor immediately for this “warning shot” is really a “wake-up call”. A devastating stroke may just about to happen.

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