Mini Strokes

SHARYL ATTKISSON: A lot of people just write them off as "spells", brief feelings of dizziness, vision loss or slurred speech. Yet, such spells may actually be "mini-strokes", early warning signs that a person is at risk for a full-blown stroke. The good news is there are a variety of treatments to lower the risk. And one of the most exciting is a new high-tech procedure that allows doctors to venture deep within the brain. HealthWeek's Andrew Holtz explains.

ANDREW HOLTZ: This is how most people picture a stroke, an emergency that strikes out of nowhere, suddenly landing its victims in the hospital without warning. But, in reality, strokes often are not a complete surprise. Like many stroke victims, C.J. Kao did get some warnings before the "big" one. Mini-strokes, known as transient ischemic attacks, or "TIAs." They stem from the same things that cause severe strokes: hardening of the arteries in or near the brain, or clots that break loose and lodge in the brain.

GREGORY ALBERS, MD, STANFORD STROKE CENTER: "Typical symptoms could be weakness on one side of the body, numbness on one side, trouble speaking, loss of vision in one eye."

ANDREW HOLTZ: In contrast to severe strokes, patients usually feel fine a few minutes after a TIA. Peter Neukirchner's mini-strokes were traced to a narrowed artery inside his brain. Doctors prescribed blood-thinning drugs. But he still had symptoms.

PETER NEUKIRCHNER: "You're totally helpless. You can't speak, it's hard to see things, and then after, say, 15 to 20 minutes, you return to perfectly normal."

ANDREW HOLTZ: Patients, like Peter, face a one in ten chance of suffering a major stroke within a year.

PETER NEUKIRCHNER: "Not knowing what's next. If you have a stroke and are crippled for life, that's a serious thing."

ANDREW HOLTZ: So, Peter was one of the first to sign up for a new high-tech procedure at the Stanford University medical school. Doctors are able to open arteries deep inside the brain without making any incisions in the skull. Thin catheters are inserted into an artery in the patient's leg and then snaked up through the chest and neck, until they reach the brain's blood vessels. Then, a tiny balloon attached to the catheter is inflated and used to push open narrowed sections of the artery.

DOCTOR: "And that's what it looks like dilating up and expanding the blood vessel."

ANDREW HOLTZ: This angioplasty procedure is, technically, essentially the same as the very common procedure used to improve blood flow to the heart muscle. But in this case, the workplace is the brain, and that makes the issue much more delicate.

PETER NEUKIRCHNER: "I was afraid of the risk, but I was more afraid of having more TIAs."

ANDREW HOLTZ: And nearly four years later, his gamble is still paying off. The angioplasty, along with medication, made his mini-strokes a thing of the past.

PETER NEUKIRCHNER: "It didn't improve my handicap in golfing. (Laughs) But other than that, I feel great. I feel better now that I did five years ago."

TIA DIAGNOSIS

SHARYL ATTKISSON: The symptoms of TIAs often mimic other medical problems, like migraine headaches or inner-ear problems. That, along with the fact that the symptoms last for just a short time, can make TIA's very difficult to diagnose. So, to detect TIAs before a person suffers a serious stroke, doctors are increasingly turning to brain scans. And one of the most useful is this new form of MRI called "Diffusion-Weighted Imaging."

DOCTOR: On the conventional, normal MRI images, these strokes are so small that they can't be seen. But the diffusion-weighted image shows these small strokes very clearly. You can see where the arrows are pointing to these bright spots. These are all tiny little strokes.

SHARYL ATTKISSON: Right now, diffusion-weighted MRI is available only at large hospitals, usually those with special stroke centers. There are also some less high-tech ways to head off stroke. Lifestyle changes like stopping smoking, eating a low-fat diet, and controlling blood pressure can help. Also, if you happen to have diabetes, it's important to watch your blood sugar. People with diabetes have a three to four times greater risk of stroke.

HEALTHNOTE

A smoker's stroke risk returns to normal within 4 years of quitting.

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