TRANSIENT ISCHEMIC ATTACK (TIA) by Elizabeth Gazda-Smith, M.D. A transient ischemic attack is a brief focal neurologic deficit that resolves without any permanent neurologic impairment. Most cases are due to a small cerebral embolism or transient thrombosis (clotting) of a cerebral or carotid artery in an individual with underlying atherosclerotic disease. Others may be caused by emboli from the heart or elsewhere in the vascular system. An attack may last for a few minutes or a few hours, but ultimately it disappears without any residual neurologic impairment. Symptoms and signs such as numbness, weakness, dizziness, fainting, vision defects or aphasia (difficulty with speech) are typical of TIA and usually lead to the diagnosis. However, because of the fleeting nature of attacks, the physician's diagnosis is made in most cases from history alone, rather than by physical exam or laboratory testing. Follow-up testing, such as carotid studies and head CT or MRI scans may reveal evidence of atherosclerotic disease or previous stroke. Amaurosis fugax is a term for temporary monocular (one eye) or partial blindness, lasting ten minutes or less. Amaurosis fugax is a form of a transient ischemic attack. The incidence of transient ischemic attacks is much greater in the elderly and more common in males. Approximately 68,000 cases of TIA occur in the United States per year. The underwriting significance relates to the fact that affected persons are at an increased risk of stroke. If untreated, one-third will go on to a completed stroke, one-third will have further TIAs, and one-third will have no further problems. Early mortality following a transient ischemic attack tends to be high, with deaths occurring from both stroke and coronary heart disease (heart attack). If atherosclerotic lesions are present in multiple cerebral arteries or if there has been a history of multiple episodes of transient ischemic attacks, the risk is increased. Medical treatment may include the use of anticoagulants (blood thinners) and artery dilators. Surgical treatment may be used to enlarge an obstructed artery (endarterectomy), or to bypass the obstruction with a graft. The rating for an applicant with history of a transient ischemic attack starts out at a minimum of table C. Applicants with known cerebrovascular or coronary artery disease will generally be rated higher than a table C. Continued cigarette smoking, uncontrolled hypertension, diabetes and elevated cholesterol increase the risk associated with transient ischemic attacks and will increase the overall rating. To get an idea of how a client with a TIA history would be viewed in the underwriting process, feel free to use the Ask "Rx" perts below for an informal quote. TIA - Ask "R x" perts (ask our experts)                                 Broker_______________________Phone_________________FAX__________________                                 Client _____________________Age DOB________________Sex___________________                                 If your client has had a Transient Ischemic Attack, please answer the following:                                 1.   Please list date(s) of the TIA(s) ________________________________________                                 2.   Please list date(s) of the TIA(s)                                       c   carotid ultrasound ____________________(date)                                       c   head CT scan or MRI scan _____________(date)                                       c   echocardiogram ______________________(date)                                 3.   Please check if your client has had any of the following:                                     c   elevated cholesterol c   stroke       c   diabetes c   heart attack       c   peripheral vascular disease c   high blood pressure       c   coronary artery disease                                             4.   Has surgery ever been done on the carotid artery(ies)?                                       c   yes, please give details _______________________________________                     c   no                         5.   Is your client on any medications?                                       c   yes, please give details _______________________________________                                       c   no                                 6.   Please give the date and result of the most recent blood pressure reading: __________                                                                 7.   Has your client smoked cigarettes in the last 12 months?                                     c   Yes                                                           c   No                                                                                     8.   Does your client have any other major health problems (example: stroke, etc.)?                                       c   Yes, please give details__________________________________                                       c   No                     After reading the Rx for Success on TIA, please feel free to use this Ask "Rx" perts for an informal quote Dr. Betty Gazda-Smith joined The Prudential in August of 1990 as Director of Medical Services for the Prudential Agencies in Plymouth, Minnesota. She transferred to Prudential Select Brokerage in March, 1993 and was promoted to Vice President and Chief Medical Officer in January, 1994. Prior to joining Prudential, she practiced Internal Medicine in downtown Minneapolis. Betty is board certified in Internal Medicine and Insurance Medicine. Betty is a member of the American Medical Association, Minnesota Medical Association, Twin City Medical Directors Association, and American Academy of Insurance Medicine. She has had multiple publications including a regular column in Broker World. Prudential Select Brokerage