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Mini-strokes

3 October 2022 | 18 mins read | Mini-strokes

What is a Transient Ischemic Attack?  

Transient ischemic attacks, known as ‘TIAs’ for short, are also called “mini-strokes”.  These can happen to anyone at any age, even to someone who eats well, exercises, and has no known major risk factors.   

Recently the celebrity Hailey Bieber – a 25-year-old model and wife of the pop-star Justin Bieber – publicly described her experience with a TIA. As doctors explained it to her, it was the result of a “perfect storm” of taking birth control pills (of which certain formulations are known to increase clot risk), recent international plane travel during which she stayed seated for hours on end, and an undiagnosed patent foramen ovale.  Without the medical testing she had immediately following the TIA, the hole in her heart would not have been discovered and repaired, and she would have been at risk for a second, possibly severe stroke.   

Normally, oxygen and important nutrients are delivered to the brain and spinal cord by the blood. In a TIA, blood flow is temporarily blocked. 

 

Transient means temporary or short-lived. 

Ischemic’ means that blood flow is restricted.  As a result, oxygen and nutrients aren’t delivered to their destination. 

The ‘attack is to the area of the brain or spinal cord that is affected by the restricted blood flow. 

Each area of the brain controls a specific function, such as speech or balance.  Without blood flow, that function is temporarily lost.   

Both TIAs and strokes result from an ischemic attack; however, in a stroke the damage can be permanent or require months of recovery and therapy to regain function.  

 

What happens to the body during a TIA?  How do they start? 

TIAs can start for many reasons, all of which prevent blood from flowing normally. These reasons include:  

Damage to the inner wall of a blood vessel caused by a buildup of fatty deposits called ‘plaque’. Plaque can block the flow of blood to that area causing a clot, or it can break off and travel to a smaller blood vessel.  

Pooled blood.  For example, in a condition called atrial fibrillation (“A-fib”) blood can pool in one of the upper chambers of the heart.  Pooled blood is more likely to form a clot than actively circulating blood. Stroke-causing clots travel to the brain, spinal cord, or retina.  

Hypercoagulation.  In a hyper coagulated state, blood tends to clot when clotting is not necessary or desirable.   

Too little circulating blood, or blood that is too thick to circulate freely.  

Without the delivery of oxygen and nutrients found in blood, the affected area of the brain is unable to properly function.  The signs and symptoms of the TIA will depend on which part of the brain is affected.  

Within a short period of time, typically 24 hours at most, the clot or blockage spontaneously resolves or breaks down without medical intervention. Ultimately, full function returns.  

 

What are the signs and symptoms of a TIA?  

Signs and symptoms of a TIA depend on where blood flow is restricted. They can include:  

  • Loss of vision in one or both eyes 
  • Loss of balance or coordination 
  • Facial drooping 
  • Weakness, lack of sensation, or paralysis usually on one side of the body 
  • Confusion 
  • Inability to form words or slurred speech 
  • Inability to understand words 

 

A simple way to quickly tell if someone is having a TIA (or a stroke) is the FAST method.   

  • F stands for “face”. Ask the person to smile (F for face) and note if the smile is even or if one side is drooping.  

  • A stands for “arms”. Ask the person to lift their arms.  Can they raise them? Can they raise them evenly?  Does one drop back down?  

  • S stands for speech. Does their speech sound slurred? Are they able to form words and make sentences?  
  • T stands for time – a reminder that there is a limited window for some stroke treatments, and that you should get the person to a hospital as quickly as possible.  If there is an emergency services phone number in your area, call to get help and transportation right away.  Don’t wait to see if the TIA resolves.  

 

Why is it important to get medical help even if all of the symptoms are gone?   

Although TIAs do resolve on their own, one third of people who have a TIA go on to have a stroke within a year.  In fact, approximately 15% of people who have a stroke have already had a TIA. 

 

If the symptoms are gone, why is a TIA still considered an emergency? 

Although it may seem strange to walk into an emergency room appearing healthy, uninjured, pain-free, and with normal vital signs, the risk of having a stroke is highest in the first 48 hours after a TIA. In fact, in one large study of people who had ischemic strokes within 30 days of a TIA, 42% occurred within the first 24 hours.    

In addition, it is important to: 

  • Find out if you have an underlying condition that caused the TIA.  That condition can then be treated.  
  • Start on medication to prevent a stroke from happening. 
  • Find out if you have risk factors for stroke.   

Approximately two thirds of stroke patients who are believed to not have any major risk factors for stroke are found to have at least one undiagnosed major risk factor.  

 

What are the risk factors for a TIA or stroke?  

Risk factors for TIA or stroke include: 

  • High blood pressure (the largest risk factor) 
  • Diabetes 
  • Metabolic syndrome  
  • Obesity 
  • Atrial fibrillation 
  • Cardiovascular disease 
  • Smoking  
  • Heavy alcohol use 

Hypercoagulable states, which can be caused by:

  • Cancer, or cancer treatment 
  • Certain genetic conditions 
  • Some meds 
  • Some infections 

When underlying conditions are resolved, the risk of TIA or stroke is greatly reduced.  

Younger people have similar risk factors, but doctors will also look for:  

  • Genetic (inherited) clotting disorders 
  • Stimulant drug use 
  • Use of ‘street’ drugs such as heroin 
  • Patent foramen ovale, a common condition in which an opening exists between the two upper chambers of the heart.  

Studies are mixed as to whether having had a Covid-19 infection increases the risk of stroke.   

 

How can TIAs be prevented?  

Preventing TIAs centers on reducing one’s risk factors. Most of these risk factors involve an elevated risk of developing numerous conditions, not only TIAs.  

  • Eat a heart-healthy diet such as the Mediterranean diet, with an emphasis on plant-based foods and fish.  Avoid processed foods and foods high in saturated fat.  
  • Lose weight. 
  • Increase exercise and physical activity. 
  • Take medication as prescribed.  Medications for stroke prevention include low-dose aspirin and warfarin/coumadin.  
  • Ask your doctor about long-term monitoring for atrial fibrillation. A-fib is one of the leading causes of strokes.  In people hospitalized for further testing after a TIA, A-fib is diagnosed in only two to three percent.   In people who used a long-term implantable or wearable monitoring device, A-fib is diagnosed in 15 – 18%.   
  • Take an on-line Stroke Risk Assessment test or ask your doctor to evaluate your risk of stroke. 

Doctors now know that there is no such thing as “just a TIA”. In fact, a TIA is a loud, all-caps warning signal that you are at increased risk of stroke. Take the warning signal very seriously. 

 

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