Am I doing the right thing by following the doctor's orders and not bringing my mom in when she has a TIA?

3 answers | Last updated: Nov 12, 2016
Wildwicked asked...

My mother has had a long series of TIA's she is 96. When take to the hospital during or after one of these we are told they can't do anything for her. I have actually been told it is not necessary to take her to the emergency because they can't do anything for her. Per her Dr. she is taking Plavax and low dose asprin and he says she may stroke our or not. I now just comfort her when she has an incident. Am I doing the right thing??

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Very sorry to hear about this situation.

It is somewhat hard to answer this question without knowing some of the specifics of her situation.  Some TIAs are caused by small artery disease - which are very tricky to treat.  Some are caused by larger artery plaques, which are often amenable to medical or interventional therapy.  I try not to let someone's age deter me from intervening, but it might be that she is too frail to go through a procedure - the last thing you want for you mother is a complication of a procedure.  Some are caused by heart disease, which should be treatable with blood thinners.

Another issue to consider is that these are not TIA's at all.  I have found that small seizures, particularly in patients with very stereotyped episodes, can frequently mimic TIA in older patients.  This is particularly true in patients with recurrent "TIAs" as "TIAs" should eventually cause strokes.  It would be somewhat unusual for a person to simply have one TIA after another indefinitely.  Older patients are at high risk of small seizures due to scarring and atrophy of the brain.  An electroencephalogram (or EEG) could be very helpful to make sure that these events are not actually small seizures.  Seizures are very treatable, and shouldn't be overlooked.

Community Answers

So tired answered...

I'm so glad wildwicked asked this question as I am struggling with the same situation with my 94 yo mother. Mom has 2 strokes several years ago, triple bypass surgery, a pacemaker and carotid artery surgery and is now having a series of TIAs. She was hospitalized for a week in Sept with one TIA after another. They gave her CT scans but these ministrokes did not show up. They adjusted her blood pressure medicine parameters higher because they found when her BP was lower she would have another TIA. They put her on Aggrenox 2x a day and sent her home. They said it was not necessary to bring her to the hospital for future TIAs. While the home healthcare nurse was here, mom had a spell that I thought was another TIA. She thought it looked like a small seizure. What's my next step? Should she see her cardiologist or a neurologist? She is wheelchair bound and it's very difficult to get her to any doctor. Thanks, so tired

Jainnagraj answered...

It is important in the case of old people to observe if the patient is stable deteorating or improveing. It will take very long to even decide this.