Stroke Risk: Any Age, Any Time?

While often referred to as a mini stroke, a transient ischemic attack (TIA) is a serious medical emergency that can affect people of all ages. TIA is a temporary blockage of blood flow to the brain, usually caused by a blood clot, and can lead to a full-blown stroke if left untreated. The risk of experiencing a TIA increases with age, but young adults are not exempt, with approximately 10-15% of strokes occurring in adults aged 18-50. As such, it is crucial to be aware of the signs of a TIA and to seek immediate medical attention if you or someone around you exhibits any stroke-like symptoms.

Transient Ischaemic Attack (TIA)

A transient ischaemic attack (TIA) is often referred to as a "mini-stroke". It is caused by a temporary disruption in the blood supply to the brain, resulting in a lack of oxygen. This can cause symptoms similar to a stroke, such as speech and visual disturbances, and numbness or weakness in the face, arms and legs. However, unlike a stroke, the effects of a TIA only last a few minutes to a few hours and fully resolve within 24 hours.

Anyone can have a TIA, but the risk increases with age. Stroke rates double every 10 years after the age of 55. People of Asian, African or Caribbean descent are also at a higher risk. Other major risk factors include high blood pressure, diabetes, heart disease, atrial fibrillation and smoking.

It is important to recognise the signs of a TIA, which can be remembered with the acronym FAST:

• Face: the face may droop on one side, the person may be unable to smile, or their mouth or eye may droop
• Arms: the person may be unable to lift or keep one or both arms raised due to weakness or numbness
• Speech: their speech may be slurred or they may be unable to talk at all, or they may have difficulty understanding others
• Time: it is crucial to call emergency services immediately if you observe any of these signs or symptoms

While a TIA does not cause permanent damage, it is a "warning stroke" that indicates a possible full-blown stroke in the future. Therefore, it is important to seek immediate medical attention if you experience any symptoms of a TIA.

Following a TIA, it is recommended to make certain lifestyle changes to reduce the risk of another TIA or a full stroke. These include maintaining a healthy weight, eating a balanced diet, and doing regular exercise. Medications may also be prescribed to treat the underlying cause of the TIA. In some cases, surgery may be required to unblock the carotid arteries, which supply blood to the brain.

Risk factors for stroke

Transient ischemic attacks (TIAs) are often referred to as "mini-strokes", but this is not an accurate name as they are very serious and can affect large areas of the brain. A TIA is a temporary blockage of blood flow to the brain, usually caused by a blood clot. While the symptoms of a TIA are temporary, it is a warning sign that a full stroke may occur in the near future.

There are many risk factors for stroke, some of which can be controlled and some which cannot. The risk of having a stroke increases with age, and the chance of having one doubles every 10 years after the age of 55. However, strokes can occur at any age, and about one in seven strokes occur in adolescents and young adults aged 15 to 49.

• Genetics and family history: Your risk of stroke is higher if a parent or other family member has had a stroke, especially if they were younger when it occurred. Certain genes affect your stroke risk, including those that determine your blood type. People with blood type AB have a higher risk.
• Sex: Men are more likely than women to have a stroke at younger ages, but because women tend to live longer, their lifetime risk of having a stroke is higher. Women who take birth control pills, use hormone replacement therapy, or are pregnant are also at higher risk.
• Race and ethnicity: In the United States, stroke occurs more frequently in Black, Alaska Native, American Indian, and Hispanic adults than in White adults.
• Previous stroke or TIA: If you have already had a stroke or TIA, your chances of having another stroke are higher.
• High blood pressure: High blood pressure is a leading cause of stroke and is the main cause of increased risk among people with diabetes.
• Cholesterol: High cholesterol levels can cause a build-up of cholesterol in the arteries, including those in the brain, which can lead to a blockage.
• Heart disorders: Common heart disorders such as coronary artery disease, heart valve defects, irregular heartbeat, and enlarged heart chambers can increase the risk of stroke.
• Diabetes: Diabetes causes sugars to build up in the blood and prevent oxygen and nutrients from reaching the brain. People with diabetes often also have high blood pressure.
• Obesity: Obesity is linked to higher levels of "bad" cholesterol and lower levels of "good" cholesterol. It can also lead to high blood pressure and diabetes.
• Sickle cell disease: This blood disorder is linked to ischemic stroke and mainly affects Black children.
• Lifestyle choices: Unhealthy lifestyle choices such as a lack of physical activity, a diet high in saturated fats, trans fats, and cholesterol, excessive alcohol consumption, tobacco use, and illegal drug use can all increase the risk of stroke.

Warning signs of stroke

Transient ischemic attacks (TIAs) are often referred to as "mini-strokes", but this term is misleading as they are just as serious as full strokes. A TIA is a temporary blockage of blood flow to the brain, usually caused by a clot, and the symptoms can last from a few minutes to 24 hours. During this time, brain cells malfunction and start to die, so a TIA is a medical emergency that requires immediate attention.

The National Stroke Association has developed the acronym FAST to help you recognise the warning signs of a stroke or TIA:

• Face: Does one side of the face droop or is it numb? Ask the person to smile—is their smile uneven?
• Arm: Is one arm weak or numb? Ask the person to raise both arms—does one arm drift downward?
• Speech: Is the person's speech slurred or are they experiencing difficulty understanding others?
• Time: If you observe any of these signs, call 911 immediately. Note the time when any of the symptoms first appear.

Other warning signs of a stroke or TIA include:

• Numbness, especially on one side of the body
• Confusion or trouble understanding others
• Clumsiness or poor coordination
• Severe headache with no apparent cause
• Loss or dimming of vision in one or both eyes
• Dizziness or loss of balance
• Nausea or vomiting
• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma

Preventing stroke

Transient ischemic attacks (TIAs), or "mini-strokes", are temporary blockages of blood flow to the brain. While TIAs don't cause permanent damage, they are warning signs of a possible full-blown stroke in the near future. The risk of experiencing a TIA increases with age, with stroke rates doubling every 10 years after the age of 55.

Lower Blood Pressure

High blood pressure is a significant risk factor for strokes, and it is the biggest contributor to stroke risk in both men and women. Monitoring and treating high blood pressure can be a critical step in reducing the chances of a stroke. Aim to maintain a blood pressure of less than 120/80, but consult with a doctor to determine the most suitable target range for your specific circumstances.

Maintain a Healthy Weight

Obesity and being overweight are associated with an increased risk of stroke, as they are often linked to other complications such as high blood pressure and diabetes. Losing weight can have a substantial impact on reducing stroke risk. Work with a healthcare professional to develop a personalised weight loss strategy.

Healthy Diet

Adopting a healthy diet can help manage blood pressure and cholesterol levels, which are crucial factors in stroke prevention. Reduce salt and high-cholesterol food intake, and increase consumption of fruits, vegetables, fish, whole grains, and low-fat dairy products.

Exercise Regularly

Regular exercise contributes to weight loss, lowers blood pressure, and acts as an independent stroke reducer. Aim for at least 30 minutes of moderate-intensity exercise, five days a week. Walking, golfing, and playing tennis are great ways to incorporate more movement into your routine.

Treat Atrial Fibrillation

Atrial fibrillation is an irregular heartbeat that can cause clots to form in the heart, leading to a stroke. If you experience symptoms such as heart palpitations or shortness of breath, consult a doctor to discuss treatment options, which may include anticoagulant drugs.

Control Blood Sugar

High blood sugar can damage blood vessels over time, making clot formation more likely. Monitor blood sugar levels and work with a healthcare professional to keep them within the recommended range through diet, exercise, and medication if necessary.

Quit Smoking

Smoking accelerates clot formation and increases plaque buildup in the arteries, significantly raising the risk of a stroke. Quitting smoking is one of the most powerful lifestyle changes that can be made to reduce stroke risk. Consult a doctor for advice and support on quitting.

Limit Alcohol Consumption

Drinking alcohol in moderation is important, as excessive consumption can lead to high blood pressure, a major cause of strokes. Limit alcohol intake to no more than one drink per day for women and no more than two drinks per day for men.

Know the Warning Signs

Educate yourself about the warning signs of a stroke, such as sudden numbness or weakness on one side of the body, sudden confusion or speech difficulties, severe headaches, and vision problems. If you or someone around you experiences these symptoms, call emergency services immediately.

Remember, while age and family history are non-modifiable risk factors, there are numerous other factors that can be controlled and managed to reduce the chances of experiencing a stroke.

Treating stroke

Transient ischemic attacks (TIAs) are often referred to as "mini-strokes", but this is not an accurate name as they can affect large areas of the brain. A TIA is a temporary blockage of blood flow to the brain, usually caused by a blood clot, and its symptoms can last from a few minutes to up to 24 hours. While a TIA doesn't cause permanent damage, it is a warning sign of a possible stroke in the near future. Therefore, it is important to seek immediate medical attention if you experience any symptoms of a TIA or stroke, such as balance issues, vision changes, face and arm drooping, and speech difficulties.

Treating a stroke:

The treatment for a stroke will depend on the type of stroke, the time that has passed since the onset of symptoms, and the patient's medical history. In the first 24 hours after a stroke, treatment options may include:

• Medicine to dissolve blood clots in the brain (thrombolysis)
• Surgery to remove a blood clot (thrombectomy) or drain fluid from the brain
• Procedures to stop pressure from building up inside the skull or brain

Medicines for stroke prevention and to aid recovery may include:

• Anticoagulants to prevent blood clots from forming or growing larger
• Blood pressure medications to reduce strain on blood vessels
• Statins to lower cholesterol levels and reduce the buildup of cholesterol inside blood vessels
• Blood thinners to reduce the risk of clot formation and blockage in blood vessels

In addition to the above, catheter-based procedures may be used to open up blocked arteries and restore blood flow to the brain. These procedures include:

• Endovascular thrombectomy to remove the blood clot
• Stenting to place a mesh scaffold-like device inside a blood vessel, holding it open and allowing blood to flow through
• Angioplasty to widen narrowed arteries by inserting a balloon or small mesh tube into the artery and expanding it

It is important to note that the sooner treatment for a stroke begins, the better the chances of recovery. Therefore, seeking immediate medical attention is crucial if you or someone around you is experiencing stroke symptoms.

Frequently asked questions