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TIA "mini stroke" may increase risk for serious stroke

Houston Texans coach Gary Kubiak's players and peers expressed surprise that the physically fit 52-year-old had a medical issue, later confirmed to be a transient ischemic attack (TIA), or "mini stroke."

"You don't think anything like that would happen to him," Texans running back Ben Tate said to the team's websiteSunday. "He's a guy who is mostly in good shape, he's in good health."

One expert says the coach's public collapse on the field is an opportunity to raise awareness for TIAs and strokes, and why it's so important to get help as soon as possible.

"It can certainly happen to people who otherwise appear to be completely healthy," Dr. Lee Schwamm, director of acute stroke services at Massachusetts General Hospital in Boston, told "That's the irony of it."

Kubiak collapsed on the field last Sunday at halftime as his team took on the Indianapolis Colts. He dropped to his knees and was seen holding his head in his hands before he was carted off the field in a stretcher and rushed to the hospital.

He was discharged Tuesday, but is out of coaching indefinitely, according to the team.

A stroke is a blockage in blood flow to the brain that can result in serious disability or death. On average, one occurs every 40 seconds, affecting about 795,000 people each year, according to the American Stroke Association.

About 15 percent of strokes are caused by bleeding in the brain when a blood vessel bursts -- what's known as a hemorrhagic stroke.

The other 85 percent are caused by a blockage in an artery that feeds the brain with blood, often by cholesterol that builds up to form plaque. A blood clot could also break off from somewhere else in the body and lodge itself like a cork in a vessel it can't pass through. This blockage prevents oxygen and glucose from reaching the brain, causing cells to die literally within minutes, Schwamm explained.

Symptoms include sudden dizziness, headache, numbness, vision loss or unconsciousness. Traditionally, a TIA has been defined as a stroke with symptoms that resolve within 24 hours without causing permanent damage. Recent research suggests a TIA might last about 10 or 15 minutes and cause irreversible brain damage that may not affect how a person acts, but can be seen on an MRI scan. One recent research paper that tracked TIA sufferers for five years found mini strokes may even knock off quality years to a victim's life.

All types of strokes are most common in adults over 65, but recent research suggestsrates have increased by 25 percent in adults younger than 64 over the past two decades.

The risk factors behind TIAs are the same that cause major strokes. That's why it's essential to get into a doctor immediately after experiencing symptoms to find the root cause of the episode, said Schwamm. TIAs and strokes could be caused by atrial fibrillation, a clot or a small tear in an artery, substance abuse, infections in the heart valve and undiagnosed cancers that are producing blood clots. Others have unexplained causes, but getting into the doctor may be the best way to prevent another episode.

Up to 30 percent of people who have a TIA experience a stroke in the following year, 10 percent will have a stroke within 30 days and of that group, and half of them will have a stroke within two days.

"Having a TIA is an incredibly important warning sign that you're at major risk for a stroke," Schwamm, who has no involvement in the coach's care, emphasized.

He questioned whether theclot-busting drug given to the coach at the hospital, tissue plasminogen activator (tPA), suggests a more serious stroke occurred.

Since TIAs typically last 15 minutes or less, he speculated that if the coach still had symptoms by the time he arrived at the hospital, doctors may have aborted a more serious stroke buy giving him the tPA medication. He pointed out tPA is rarely given as a precautionary measure, given it can increase risk for bleeding in the brain.

If it was a TIA as reported and doctors are confident he's stable or found the root cause, Kubiak could return shortly. If it was actually a stroke, he may need to be held out longer. Schwamm added some patients take time off due to the trauma of the episode.

He hopes the news will get people to not ignore symptoms of a stroke or TIA. Many patients who experience a TIA try to take a nap and ignore them, hoping they'll feel better when they wake up. But he warns, "where there's smoke, there's fire."

"The reality is stroke is unfortunately experienced by people from all walks of life, from babies to 100-year-olds," he said. "The challenge is to find the needle in the haystack."

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