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Ask the Medical Expert Archives 2000-2004

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TIA
August 2000

Q. I am writing to get a better understanding of my diagnosis of transient neurologic deficit, non-TIA. I was hospitalized after I started to lose my vision in both eyes. Vision returned, and there were no problems with the heart monitor in the hospital or otherwise. They ruled out TIA and I am having a transesophageal next month. I am still taking aspirin per doctor's order. Could this be cardiology related or more related to the brain?

A. A TIA refers to transient ischemic attack, meaning there is an interruption of oxygen supply to an area of the brain. These are sometimes even called "mini-strokes" meaning some brain function was affected but the symptoms resolved in less than 24 hours. The terms TIA and transient neurologic deficit seem the same from the standpoint of diagnosis and treatment. They are usually thought of as indicating the person is at high risk for a stroke in which permanent damage will occur. The TIA is a warning sign that urgent measures are needed to prevent a stroke and determine the cause of the symptoms. Aspirin or other blood thinners are usually prescribed for treatment as tests are being done to find the cause.

The specific symptoms you describe affecting the vision has a particular name, amaurosis fugax, in which the blood supply to the vision area of the brain was affected. Fortunately the symptoms cleared in your case.

The majority of ischemic events are caused by blood clots or other conditions in which blood flow is interrupted, although about 20 % of cases are due to bleeding within the brain. Known risk factors for stroke and TIA include high blood pressure, smoking, high cholesterol, diabetes, and excess alcohol. Tests to locate blood clots will include studies of the blood vessels in the legs, neck, and heart as you are undergoing. If serious blockage is found in a major vessel, treatment may be needed. If nothing definite shows on these tests, less common conditions can be investigated on blood testing. A neurologist and possibly a hematologist are the specialists who are usually directing treatment of such cases.

HELPFUL WEBSITES:

  • http://www.ninds.nih.gov/
  • http://www.stroke.org/index.html
MEDICAL REFERENCES (usually available through the library of your local hospital):
  • Ahuja RM, Chaturvedi S, Eliott D, Joshi N, Puklin JE, Abrams GW.
    Mechanisms of Retinal Arterial Occlusive Disease in African American and Caucasian Patients. Stroke. 1999 Aug;30(8):1506-9.
  • Mizener JB, Podhajsky P, Hayreh SS.
    Ocular Ischemic Syndrome. Ophthalmology. 1997 May;104(5):859-64.
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