Stroke experts applauded Gov. Lawton Chiles for heading to the hospital immediately after he experienced weakness, slurred speech and other classic signs of a stroke.
Quick medical attention, they say, will give the governor a good chance of avoiding a full-blown stroke in the future.
Surprisingly, many people ignore the temporary symptoms of a transient ischemic attack, or TIA, like the governor had Wednesday morning. But an attack of even a few seconds is an indication of an underlying problem that needs medical treatment, doctors said.
"Most of the patients that are admitted to the hospital with a disabling stroke had a history of transient ischemic attacks in the past," said Dr. Erfan Albakri, director of the stroke program at the University of South Florida and Tampa General Hospital. "They thought it was nothing serious."
Although state officials did their best to avoid any use of the word stroke on Wednesday, medical experts say a TIA or mini-stroke is a strong indication that a person is at high risk for a stroke.
In both a TIA and a stroke, the blood flow to the brain is blocked and a person experiences symptoms such as weakness, slurred speech, blurry vision, and disorientation. In a TIA, the blockage disappears quickly and there is no permanent damage to the brain. If the symptoms last less than 24 hours, the incident is classified as a TIA. A stroke occurs when the disrupted blood flow causes permanent damage.
"A TIA is a second chance," said Dr. Michael Walker, director of the National Institute of Neurological Disorders and Stroke in Bethesda, Md. "It is a very powerful warning."
Many TIAs occur when an artery becomes blocked by a blood clot or a piece of fatty deposit inside the artery. The clot or deposit then dissolves or breaks up and blood flow is restored before permanent damage is done. In some cases, a spasm of the artery can cause temporary blockage.
In Gov. Chiles' case, doctors believe the blockage occurred in the basilar artery at the base of the brain.
What's important now is for doctors to determine what caused the blockage, which may or may not be related to the heart problems that caused Chiles to undergo a quadruple heart-bypass operation in 1985.
The problem could be in the artery itself. A person who developed clogged arteries around the heart is also at risk for developing clogged arteries elsewhere. A narrowing of the artery can cause the blood to slow and form clots.
The problem also could be in Chiles' heart, medical experts said. A clot could have formed in narrowed arteries around the heart, then traveled until it lodged in the artery below the brain.
Doctors may never know for certain where the actual blockage occurred. But they will be able to perform tests that show whether arteries near the brain or the heart are clogged.
The treatment doctors choose depends on the underlying problem and its severity. Medication such as aspirin or a blood thinner can help prevent a stroke. In some cases, surgery can unplug clogged arteries. If the problem is in the basilar artery, though, surgery is very difficult and used only as a lastresort, Dr. Albakri said.
Stroke is the third-leading cause of death in the United States and is the leading cause of disability, in part because people often fail to seek treatment early enough. In a 1991 Gallup poll, 97 percent of people questioned could not name a single sign of a stroke.
Often, people think that tingling or numbness in an arm is a sign they slept on it, or a temporary blurring of vision is just tiredness, Dr. Albakri said.
But experts say the early warning signs of a stroke should be treated with the same urgency as chest pain.
"Patients who have chest pain call 911 immediately," Dr. Albakri said. "Now we look at stroke as a brain attack. Chest pain progresses to a heart attack. A TIA progresses to a brain attack."
What caused Chiles' illness
When blood flow is restricted or cut off to blood vessels in a particular part of the brain, the function in that part of the brain can be impaired. When a transient ischemic attack (TIA) - or "mini-stroke," which struck Gov. Lawton Chiles Wednesday - occurs, the impairment may be mild and temporary, sometimes lasting only seconds or minutes. A stroke, on the other hand, can cause permanent disability and even death.
A clump of blood cells that block an artery to the brain can often cause TIA.
The attack is temporary; the clump soon breaks up and is swept away, restoring blood flow.
TIA symptoms are similar to those of stroke. They include: Temporary weakness: a clumsiness or loss of feeling in an arm, leg or the side of the face; Temporary dimness or loss of vision, especially in one eye; Temporary loss of speech or difficulty in speaking or understanding speech. Sometimes dizziness, double vision and staggering also occur. The short duration of these symptoms and the lack of permanent damage differentiates TIA from a stroke.
Preventive measures depend on the age of the victim and his or her state of health. In some cases, it can be as simple as taking aspirin once a day. It acts as an anticoagulant, reducing the likelihood of blood clots forming in blood vessels. In other cases, surgery may be needed to remove fatty material from artery walls.
Sources: The AMA Family Medical Guide, The American Heart Association Heart & Stroke Facts
Strokes killed 144,070 people in 1991 and are the third largest cause of death, ranking behind heart disease and cancer, according to the National Center for Health Statistics.