Your Stroke Questions Answered

Douglas DeOrchis, MD,

• My mother has had several instances of tingling in her right arm. The doctor called them TIAs. What are they, and do they always lead to stroke if untreated?
  Tingling of an extremity is a non-specific symptom and may be related to many things, including TIAs. It is important that a neurologist be involved in your care to support or confirm the diagnosis. TIAs are Transient Ischemic Attacks, or transient strokes lasting less than 24 hours. The term relates more to the temporary nature than the severity of a stroke. They are important in that they may precede a permanent stroke. Weakness or altered sensations in one extremity or side of the body, difficulty with speech or sudden problems with vision may represent onset of stroke, as may severe headache or changes in mental status. All should be investigated by a physician immediately.
  
  
• If you have symptoms, what kinds of tests are done at the hospital to see if you're having a stroke?
  The doctor will perform careful history and neurologic exam, and may order a CT scan, MRI or carotid ultrasound for additional testing to correlate with other findings. CT and MRI look for changes in the brain that accompany stroke, as well as exclude other causes for the symptoms. Some strokes arise from hardening and narrowing of the carotid artery in the neck, which can be evaluated with ultrasound.
  
  
• My father had a stroke six months ago and can't use his right arm. Will he eventually regain the use of it?
  While many patients show some early improvement after stroke, particularly younger patients, after the first few days, most disability becomes permanent. Disability persisting at six months rarely improves substantially Therapeutic and occupational rehabilitation can help patients learn to live more effectively with their disabilities.
  
  
• What can be done for people today who are having a stroke?
  The most important thing for patients to do is learn the signs and symptoms of stroke, and to seek immediate attention. Patients seen within three hours, and occasionally six hours, may be candidates for treatment with clot dissolving medication called TPA. This medication is usually given intravenously, and has been shown to have statistically significant results in decreasing death and severe disability from acute stroke.
  
  There is a small risk of bleeding at the stroke site, but overall the treatment has shown benefit, but must be used early. The American Heart Association is working with physicians, ERs, EMS and public leaders to educate the public about stroke and encourage immediate medical care.

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