Recent research has highlighted new information for both patients and physicians. In fact many reputable medical journals, including a recent issue of The Canadian Medical Association Journal, contain numerous articles on prevention and treatment. There is new information to help avoid a stroke, as well as how early appropriate interventions can improve the outcomes.

A Transient Ischemic Attack will come on suddenly and unexpectedly. A brief episode of numbness, weakness, loss of vision or speech difficulty, lasting briefly but always for less than 24 hours characterize it most commonly. The vast majority of TIAs have symptoms lasting for less than one hour, prompting many patients to delay or avoid treatment. New information should motivate you or your spouse to seek immediate emergency room attention, when such symptoms develop.

Remember these important signals, as reported by the American Stroke Association:

• sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• sudden confusion, trouble with speaking or understanding
• sudden trouble with vision in one or both eyes
• sudden trouble with walking, dizziness, loss of balance or co-ordination
• sudden severe headache, with no known cause

Each year in Canada, more than 50,000 individuals will suffer a stroke

A stroke has a similar presentation, but is associated with permanent brain injury, lasts longer and in some cases, causes permanent disabilities or death.

There are two major causes of a stroke ­ blockage of a blood vessel (80 per cent) and hemorrhage from a blood vessel (20 per cent). Think of a garden hose. If the hose has a temporary kink or small amount of dirt, there will be a temporary decrease in flow (TIA). If dirt or foreign matter comes from the tap and plugs the end of the hose to significantly block it, the garden won't get the needed water (stroke) and, if the hose ruptures, a portion of the garden will be damaged from flooding (hemorrhagic stroke). The cause of TIA and stroke is usually a lack of blood supply and oxygen to a portion of the brain. In the case of a TIA, it is usually a temporary blockage while in a stroke, it is usually a more major blood vessel affected, causing permanent injury to an area of the brain. The most common causes of blockage are atherosclerosis ("hardening of the arteries"), small vessel disease in the brain, or the release of an embolism (blood clot) from the heart when one is affected by certain heart conditions. If the stroke is caused by a bleed, it is usually the result of a ruptured blood vessel or aneurysm.

Unfortunately, TIA precedes 15 per cent of stroke cases. It is imperative that optimal attention is given at the time of a TIA to decrease the risks of permanent damage. Knowing the factors which affect risk, as well as being able to identify the signs and symptoms of a TIA or stroke and seeking immediate medical attention are important to all seniors. It is well known that in many cases, early diagnosis and proper treatment can affect outcome.

The risk factors for the development of these conditions include high blood pressure, smoking, heart disease, elevated cholesterol and diabetes. It has been proven that aggressive attention to strict control of these diseases can substantially reduce risk of both stroke and other complications. In addition, exercise and weight control are the two most effective ways to not only prevent stroke, but also to prevent or control heart disease, hypertension and diabetes. It has been estimated that stroke risk may be reduced by up to 50 per cent through exercise alone. The American Heart Association recommends that at least 30 minutes of exercise become one of your daily routines on most days of the week. Physical activity need not be strenuous to bring health benefits. Brisk, but comfortable walking is the most common and is easily done by most seniors. For those with physical disabilities, swimming is a useful alternative. For seniors who have the advantage of escaping the cold weather in winter months, there is the opportunity to continue with an outside exercise program all year around. Attaining a normal weight for your age is more challenging but just as important. In addition to dietary restrictions, if necessary, exercise will help to reduce or control your weight as well.

High blood pressure must be adequately controlled. In addition to salt restriction, weight control and exercise, proper medication can bring your pressure to normal levels. The treatment should maintain your usual pressure at 140/90 or lower. Cigarettes and second-hand smoke must be avoided. A smoker in his/her senior years is at great risk for stroke or heart attack. Elevated cholesterol levels can now be reduced to normal through the use of "statin" drugs, if diet and exercise don't do it. And careful attention to controlling one's diabetes will reduce the risks associated with that disease as well as stroke.

Those with certain types of heart disease need to take special preventive measures to reduce the risk of TIA and stroke. For example, 4.5 per cent who suffer from a heart condition known as atrial fibrillation would be likely to suffer a stroke were it not for anticoagulants. Taking a "blood thinner" such as Coumadin (warfarin) reduces that annual risk to 1.5 per cent. Other conditions such as certain types of heart attack, valve diseases and congenital heart defects may also need anticoagulant therapy to help prevent stroke.

More attention must be paid to TIA by the patient, family and physician. Although symptoms have often cleared by the time the patient reaches the emergency department, careful assessment and investigation must immediately follow to identify, if possible, the cause of the event. Studies show that more than 10 per cent of such individuals will go on to have a major stroke within 90 days, half of those occurring within two days of the TIA. As this outcome can often be altered with specific treatment, patient and physician must consider the matter urgent. While most individuals will not require admission, a minimal number of tests are immediately necessary to determine the most appropriate treatment. These procedures could include blood tests, an electrocardiogram and/or echocardiogram, an ultrasound of the neck (to rule out carotid artery narrowing) and a CT scan or MRI. Recent studies in Canada show that these are not always being completed in a timely manner. Without all of the information, appropriate treatment may be delayed in some cases, thereby jeopardizing the outcome.

Treatment may begin immediately. In the urgent phase and in certain cases, "clot buster" medication may be indicated. It has been shown that Aspirin or anticoagulants may be indicated immediately in some types of TIA and urgent carotid surgery for cases in which the TIA has been found to be due to a major narrowing of part of the carotid artery in the neck. Such surgery for cases in which there is severe narrowing of an internal carotid artery to the brain is one of the most effective ways of preventing recurrent stroke, reducing the risks by up to two-thirds. Only with vigilant medical attention and the timely availability of diagnostic services, surgeon and hospital care can this reduction be accomplished.

Although there is no indication that Aspirin prevents TIA or stroke in the absence of vascular disease, once such an event occurs, Aspirin or similar drugs are usually indicated in preventing further episodes. In addition, it is now recommended that all patients who have suffered a TIA or stroke should be given a "statin" drug to lower their cholesterol, regardless of their blood cholesterol level.

TIAs and strokes have the same presenting symptoms. If these symptoms occur, they should be considered a medical emergency. Dial 911. Immediate attention at an emergency department is now the standard of care with early investigation and treatment, as indicated.

But remember the things you can do to reduce your risks in the first place. Eat appropriately, exercise and pay strict attention to any medical conditions you have that are known to increase the risk of TIA and stroke.