Dr. Aaron Heide
For the Courier-Herald
Is it a new competing car company from South Korea, like KIA? Is it the new “in” name to call your child (pronounced tee-ah)?
No, actually it is an, often, overused medical term to describe any transient focal neurological symptom. Although if I were to have another child I am sure TIA might be on the list of names. TIA stands for transient ischemic attack. It results from a brief lack of blood flow to a part or parts of the brain.
The symptoms can be almost anything, including weakness, numbness, tingling, vision loss or changes, balance difficulties, slurred speech or difficulties expressing words, dizziness, or even confusion. Because of the plethora of symptoms, diagnosing TIA has taken on a life of its own and can be easily overused.
As a vascular neurologist and stroke specialist I am frequently asked to evaluate a patient who has suffered a TIA to prevent a stroke. This is very important as the risk of someone having a completed stroke (permanent neurological injury as a result of lack of blood flow to the brain) is somewhere between 12 and 25 percent over the next 30 days after suffering from a TIA.
Most of this risk is over the first one to seven days. TIA is considered a neurologic emergency because of this high risk of stroke. However, I have found that as many as 50 percent of the patients I see with a diagnosis of TIA do not end up having a true TIA.
As the only stroke neurologist outside Seattle between Olympia and Spokane, I see a large number of patients who present to my TIA clinics to be assessed for their risk of stroke and provide treatment to prevent a stroke. I find that many patients who come in with symptoms of TIA ultimately end up with a cause of their symptoms that is not due to a transient loss of blood flow to their brains. The diagnoses can range anywhere from a migraine without headache (yes, migraines are not headaches and can have transient neurological symptoms without a headache. I know because I get them), sleep dysfunction, medication use or even a vitamin deficiency or a combination of the above.
Even though a TIA could be a symptom of something less scary than an impending stroke it is still a good idea to get it checked out immediately to make sure it isn’t a true TIA.
That is why I see patients in my TIA clinics within 24 to 48 hours of their symptoms and often the same day when the symptoms are more concerning. Many patients do not address the symptoms right away, understandably so, because as by definition, the symptoms of a TIA are transient and completely resolve. They feel that since it resolved there is no longer a concern. This isn’t further from the truth. They also feel if they go to an emergency room they will have to wait for an extended period of time to be assessed. This is often the case as the secret to getting an urgent evaluation at an emergency room is to have the acute onset of neurological deficits that do not go away.
So then the question is where and when is the best way to evaluate symptoms of TIA? Sooner the better is the answer. However there are practical factors to consider such as is the emergency room the most appropriate place to be evaluated for a TIA. I am obviously biased.
As a stroke specialist I feel that a TIA clinic operated by a stroke neurologist can provide an urgent and efficient workup to determine if the symptoms are truly a TIA and then determine the best course of action for proper testing and treatment at a low cost.
When patients are seen in an emergency room there is an extensive workup performed that can end up being very expensive.
In a recent government publication the cost of many common diagnoses seen at hospitals determined that the charges for an ER visit for a single TIA are from $20,000 to more than $40,000.
Even with all of this cost, the patient has still not yet seen a stroke specialist to determine the cause of the symptoms to prevent a potential stroke. The costs are some of the highest for ER visits in Pierce County averaging $42,000 per TIA visit. TIA clinics operated by a vascular neurologist can offer an option to an ER visit for patients with TIA symptoms. Patients can be seen urgently by a specialist; with a focused workup tailored to the patient’s symptoms at less than 10 percent of the cost of an ER visit.
Dr. Aaron Heide operates TIA clinics in Enumclaw, Bonney Lake, Puyallup, Tacoma, Renton, and Bellevue. Immediate appointments can be made by calling 425-264-CLOT (2568).
