A TIA (transcient ischemic attack) is in essence a "mini stroke" that briefly interrupts the blood flow to the brain. Symptoms usually happen suddenly and they often disappear within an hour, although some TIA symptoms can last 24 hours or longer. Because TIAs are by definition "come and go," should you make an appointment to see your doctor?

The National Institutes of Health has recently recommended that you do not make an appointment with your doctor if you have had what you think could be a TIA. Instead, they recommend that you head straight for the emergency room.

It can sometimes take days to get an appointment with your primary care physician. Even if you can get into the office the same day, you can lose hours making an appointment and then sitting in the physician's office, only to be referred out again for scans and tests that they can't do in the office.

According to the medical experts a prompt evaluation (within 60 minutes) is necessary to identify the cause of the TIA and determine appropriate therapy.

TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke. According to research just published in the June 2, 2009 issue of "Neurology," about one-third of those who have a TIA will have an acute stroke some time in the future. As many as half the people who did have a major stroke after having had a TIA had the major stroke within 7 days of the TIA. 1.2 percent of the second strokes occurred within six hours, 2.1 % occurred within 12 hours and 5.1 % occurred within 24 hours.

"That about half of all the recurrent strokes in the seven days after a TIA occur in the first 24 hours highlights the need for emergency assessment...The risk of major stroke can be reduced by up to 80 percent simply by initiating standard treatment as an emergency measure," the researchers said. Daniel Laskowitz, M.D., associate professor, neurology, Duke University Medical Center and a co-author of this particular study added, "A TIA should send a strong warning. It is not something that needs to be seen next week."

So instead of making an appointment with your regular doctor, get to the closest and best emergency room for immediate evaluation and treatment. You will lose valuable time if you do anything else. Once there, let the patient's primary care physician know what's happening and where you are.

Make sure when you check in that the triage nurse knows that you or your loved one is having what you believe to be a TIA or a stroke.

The physician authors of this report also strongly recommend that, "For the emergency department, TIA patients should not be sent right home but should be kept for observation and tested. They can be sent home if the tests are negative and they already are started on a secondary stroke prevention regimen."

This is where your practiced advocacy skills may need to come into play. If the ER physician wants to send your senior home and you have doubts, try to contact your primary physician again for advice.

This is not something that we as caregivers want to hear. If you are like most of us, you would rather walk barefoot over broken glass than spend another minute in an emergency room. Unfortunately, the choice seems to be to get there when you first see TIA symptoms or take the chance of spending weeks/months/years in hospitals and rehab centers helping your senior get treatment for and recover from a major stroke.

To review: You may help prevent a full-blown stroke by immediately paying attention to the signs of a TIA and getting your senior to the emergency room:

Numbness or weakness in the face, arm, or leg, especially on one side of the body

Confusion or difficulty in talking or understanding speech

Trouble seeing in one or both eyes

Difficulty with walking, dizziness, or loss of balance and coordination