A transient ischemic attack (TIA) is a 

stroke that comes and goes quickly. It happens when a blood clot blocks a blood vessel in your brain. This causes
the blood supply to the brain to stop briefly. Symptoms of a TIA are like other stroke symptoms, but do not last as long. They happen suddenly, and
include

 Numbness or weakness, especially on one side of the body

 Confusion or trouble speaking or understanding speech
 Trouble seeing in one or both eyes
 Loss of balance or coordination

Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA
or a stroke, you should get to the hospital quickly.

TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also
recommend surgery.

NIH: National Institute of Neurological Disorders and Stroke

Transient ischemic attack

Mini stroke; TIA; Little stroke
Last reviewed: June 16, 2010.

A transient ischemic attack (TIA) is an episode in which a person has stroke -like symptoms for up to 1-2 hours.

A TIA is often considered a warning sign that a true stroke may happen in the future if something is not done to prevent it.

Causes, incidence, and risk factors

A transient ischemic attack (TIA) is caused by temporary disturbance of blood supply to an area of the brain, which results in a sudden, brief decrease
in brain function. (A decrease in brain function is called a neurologic deficit.)

A TIA is different than a stroke. Unlike from a stroke, a TIA does not cause brain tissue to die. The symptoms of TIAs do not last as long as a stroke
and do not show changes on CT or MRI scans. (Strokes usually show changes on such tests.)

The temporary loss of blood flow to the brain can be caused by:

 Blood clot within an artery of the brain

 Blood clot that travels to the brain from somewhere else in the body (for example, the heart)
 Injury to blood vessels
 Narrowing of a blood vessel in the brain or leading to the brain

For instance, the temporary disruption in blood flow could be due to a blood clot that occurs and then dissolves. The blockage breaks up quickly and
dissolves.

Less common causes of TIA include:

 An irregular heart rhythm called atrial fibrillation

 Certain blood disorders, including polycythemia, sickle cell anemia, and syndromes where the blood is very thick
 Conditions that cause blood vessels problems such as fibromuscular dysplasia, systemic lupus erythematosus, and syphilis
 Inflammation of the arteries such as arteritis, polyarteritis, and granulomatous angiitis
 Spasm of the small arteries in the brain

Atherosclerosis ("hardening of the arteries") is a condition where fatty deposits occur on the inner lining of the arteries. This condition dramatically
increases the risk for both TIAs and stroke. Approximately 80-90% of people who have a stroke due to atherosclerosis had a TIA episode before.
Other risks for TIA include high blood pressure, heart disease, migraine headaches, smoking, diabetes, and increasing age.

Symptoms

Symptoms begin suddenly, last only a short time (from a few minutes to 1 to 2 hours), and disappear completely. They may occur again at a later time.
Symptoms usually occur on the same side of the body if more than one body part is involved.

A TIA is different than a stroke. However, the symptoms of TIA are the same as a stroke and include the sudden development of:

 Muscle weakness of the face, arm, or leg (usually only on one side of the body)
 Numbness or tingling on one side of the body
 Trouble speaking or understanding others who are speaking
 Problems with eyesight (double vision, loss of all or part of vision)
 Changes in sensation, involving touch, pain, temperature, pressure, hearing, and taste
 Change in alertness (sleepiness, less responsive, unconscious, or coma)
 Personality, mood, or emotional changes
 Confusion or loss of memory
 Difficulty swallowing
 Difficulty writing or reading
 Lack of coordination and balance, clumsiness, or trouble walking
 Abnormal sensation of movement (vertigo) or dizziness
 Lack of control over the bladder or bowels
 Inability to recognize or identify sensory stimuli (agnosia)

Signs and tests

TIAs do not show brain changes on CT or MRI scans. (Most strokes do show changes on such tests.) Because symptoms and signs may have
completely disappeared by the time one gets to the hospital, a diagnosis of a TIA may be made on a person's medical history alone.

A physical examination should include a neurological exam, which may be abnormal during an episode but normal after the episode has passed.

Blood pressure may be high. The doctor will use a stethoscope to listen to your heart and arteries. An abnormal sound called a bruit may be heard
when listening to the carotid artery in the neck or other artery. A bruit is caused by irregular blood flow. In some cases, low blood pressure may be seen
before symptoms of a TIA occur.

Tests will be done to rule out a stroke or other disorders that may cause the symptoms.

 Head CT scan or brain MRI is almost always done.

 Angiogram, CT angiogram, or MR angiogram may be done.
 An echocardiogram may be done if your doctor thinks you may have a blood clot from the heart.
 Carotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowed. Cerebral arteriogram reveals which blood vessels is
blocked or bleeding.
 EKG and heart rhythm monitoring may be done to check for irregular heart beats.

Additional tests and procedures may include:

 Blood clotting tests to rule out a blood disorder

 Blood chemistry
 Complete blood count (CBC)
 C-reaction protein
 ECG
 ESR (Sedimentation rate)
 Serum lipids
 Tests for syphilis, Lyme disease, and other infections
Your doctor may use these tests to check high blood pressure, heart disease, diabetes, high cholesterol, and peripheral vascular disease.

Treatment

The goal is to prevent a stroke from occurring.

If you have had a TIA within the last 48 hours, you will likely be admitted to the hospital so that doctors can determine the cause and treatment.

Underlying disorders such as high blood pressure, heart disease, diabetes, and blood disorders, should be treated appropriately.

Blood thinners, such as aspirin, may be prescribed to reduce blood clotting. Others include dipyridamole, clopidogrel, Aggrenox or heparin, Coumadin,
or other similar medications. Treatment may be continued for an indefinite time period.

Surgery (carotid endarterectomy) may be appropriate for some people who have clogged neck arteries.

Smoking should be stopped.

Your health care provider may recommend a low-fat and low-salt diet. Other dietary changes may be recommended.

Expectations (prognosis)

TIAs do not cause lasting damage to the brain,

However, they are a warning sign that a true stroke may happen in the future. Over 10% of people who have TIA will have a stroke within 3 months.
Half of these strokes happen during the 48 hours after TIA. The stroke may occur that same day or at a later time. Some people have only a single
episode and some have recurrent episodes.

Your chances of a future stroke can be reduced by close follow-up with your health care provider to manage risk factors.

Complications

Complications of TIA include:

 Death of brain cells due to too little blood flow to the brain
 Injury that occurs from falls
 Stroke

Calling your health care provider

TIA is a medical emergency. Call 911 or other local emergency number immediately. Do not ignore symptoms just because they go away. They may be
a warning of a future stroke.

Prevention

Prevention of TIA includes controlling the risk factors such as high blood pressure, diabetes, heart disease, and other associated disorders. Smoking
should be stopped. See: Stroke risk factors and prevention

Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is often the first sign of COPD.
Chronic bronchitis andemphysema are common COPDs.

Your airways branch out inside your lungs like an upside-down tree. At the end of each branch are small, balloon-like air sacs. In healthy people, both
the airways and air sacs are springy and elastic. When you breathe in, each air sac fills with air like a small balloon. The balloon deflates when you
exhale. In COPD, your airways and air sacs lose their shape and become floppy, like a stretched-out rubber band.
Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or
contribute to COPD.Quitting smoking is the best way to avoid developing COPD.

Treatment can make you more comfortable, but there is no cure.

NIH: National Heart, Lung, and Blood Institute

Chronic obstructive pulmonary disease

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic
Last reviewed: October 9, 2009.

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of
COPD:

 Chronic bronchitis, defined by a long-term cough with mucus

 Emphysema, defined by destruction of the lungs over time

Most people with COPD have a combination of both conditions.

Causes, incidence, and risk factors

Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD although some people smoke for
years and never get COPD.

In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

Other risk factors for COPD are:

 Exposure to certain gases or fumes in the workplace

 Exposure to heavy amounts of secondhand smoke and pollution
 Frequent use of cooking gas without proper ventilation

Symptoms

 Cough with mucus

 Shortness of breath (dyspnea) that gets worse with mild activity
 Fatigue
 Frequent respiratory infections
 Wheezing

Since the symptoms of COPD develop slowly, some people may be unaware that they are sick.

Signs and tests

The best test for COPD is a simple lung function test called spirometry. This involves blowing out as hard as one can into a small machine that tests
lung capacity. The test can be interpreted immediately and does not involve exercising, drawing blood, or exposure to radiation.

Using a stethoscope to listen to the lungs can also be helpful, although sometimes the lungs sound normal even when COPD is present.

Pictures of the lungs (such as X-rays and CT scans) can be helpful but sometimes look normal even when a person has COPD.

Sometimes it is necessary to do a blood test (call a “blood gas”) to measure the amounts of oxygen and carbon dioxide in the blood.
Treatment

There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse.

Persons with COPD must stop smoking. This is the best way to slow down the lung damage.

Medications used to treat COPD include:

 Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), or formoterol
(Foradil)
 Inhaled steroids to reduce lung inflammation

In severe cases or during flare-ups, you may need to receive steroids by mouth or through a vein (intravenously).

Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse.

Oxygen therapy at home may be needed if a person has a low level of oxygen in their blood. Pulmonary rehabilitation does not cure the lung disease,
but it can teach you to breathe in a different way so you can stay active. Exercise programs such as pulmonary rehabilitation are also important to help
maintain muscle strength in the legs so less demand is placed on the lungs when walking. These programs also teach people how to use their
medicines most effectively.

Things you can do to make it easier for yourself around the home include:

 Avoiding very cold air

 Making sure no one smokes in your home
 Reducing air pollution by eliminating fireplace smoke and other irritants

Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about
getting foods with more calories.

Surgical treatments may include:

 Surgery to remove parts of the diseased lung, for some patients with emphysema
 Lung transplant for severe cases

Support Groups

People often can help ease the stress of illness by joining a support group in which members share common experiences and problems.

See also: Lung disease - support group

Expectations (prognosis)

This condition is a long-term (chronic) illness. The disease will get worse more quickly if one continues to smoke.

Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with
their doctor about the use of breathing machines and end-of-life care.

Complications

 Irregular heart beats (arrhythmias)

 Need for breathing machine and oxygen therapy
 Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
 Pneumonia
 Pneumothorax
 Severe weight loss and malnutrition
Prevention: quit smoking