Mini Strokes: A Years-Long Health Threat?

Transient Ischaemic Attack (TIA), or mini-stroke, is a temporary blockage of blood flow to the brain. TIA symptoms are similar to those of a stroke and can include numbness or weakness in the face, arm, or leg, especially on one side of the body, trouble seeing in one or both eyes, or double vision, and problems with walking, dizziness, and difficulty talking or understanding speech. The effects of a TIA only last for a few minutes or hours and fully resolve within 24 hours. However, a TIA is a warning sign that a person is at risk of having a full stroke in the future. About one-third of those who have a TIA will have a severe stroke sometime in the future.

Transient Ischaemic Attack (TIA)

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

The main symptoms of a TIA can be remembered with the acronym FAST:

• Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped.
• Arms – the person may not be able to lift both arms and keep them raised because of weakness or numbness in one arm.
• Speech – their speech may be slurred or garbled, or the person may not be able to talk at all, despite appearing to be awake; they may also have problems understanding what you're saying to them.
• Time – it's time to call 999 immediately if you see any of these signs or symptoms.

It's important to call for emergency medical assistance immediately if you or someone else is exhibiting symptoms of a TIA or stroke. Even if the symptoms disappear while waiting for an ambulance to arrive, it is still necessary to be assessed in a hospital. Following a TIA, you should be referred to see a specialist within 24 hours of the onset of symptoms.

During a TIA, one of the blood vessels that supply the brain with oxygen-rich blood becomes blocked. This blockage is usually caused by a blood clot that has formed elsewhere in the body and travelled to the blood vessels supplying the brain, although it can also be caused by pieces of fatty material or air bubbles. Certain factors can increase the chances of having a TIA, including high blood pressure (hypertension), high cholesterol levels, regularly drinking excessive amounts of alcohol, and having a type of irregular heartbeat called atrial fibrillation. People over 55 years of age and people of Asian, African or Caribbean descent are also at a higher risk of experiencing a TIA.

Although the symptoms of a TIA resolve in a few minutes or hours, treatment is necessary to help prevent another TIA or a full stroke from occurring in the future. Treatment will depend on individual circumstances, such as age and medical history. This may include advice about lifestyle changes to reduce stroke risk, as well as medication to treat the cause of the TIA. In some cases, a surgery called a carotid endarterectomy may be needed to unblock the carotid arteries, which are the main blood vessels that supply the brain with blood.

Symptoms of a TIA

A transient ischaemic attack (TIA) or "mini stroke" is caused by a temporary disruption in the blood supply to the brain. This disruption results in a lack of oxygen to the brain, leading to symptoms similar to a stroke. These symptoms typically arise suddenly and can last from a few minutes to a few hours, fully resolving within 24 hours.

The main symptoms of a TIA can be recognised using the acronym FAST:

• Face — the face may appear to have dropped on one side, with the person unable to smile, or their mouth or eye may have drooped.
• Arms — the person may experience weakness or numbness in one arm, making it difficult to lift and keep both arms raised.
• Speech — speech may become slurred or garbled, or the person may be unable to speak at all, even though they appear awake. They may also struggle to understand what others are saying.
• Time — it is crucial to call for emergency medical assistance if you observe any of these signs or symptoms.

Other potential symptoms of a TIA include:

• Complete paralysis on one side of the body.
• Sudden vision loss, blurred vision, or double vision.
• Problems with balance and coordination.
• Difficulty swallowing (dysphagia).
• Severe headache with no apparent cause.

It is important to be vigilant for these signs, especially if you live with or care for someone in a high-risk group, such as older individuals or those with conditions like diabetes or high blood pressure. Recognising the symptoms of a TIA promptly can help seek timely medical attention and reduce the risk of a full-blown stroke in the future.

Risk factors for a TIA

A transient ischaemic attack (TIA), or "mini stroke", is caused by a temporary disruption in the blood supply to the brain. While anyone can have a TIA, certain risk factors increase the chances of experiencing one.

Age is a significant risk factor for a TIA. Stroke rates double every 10 years after the age of 55, and TIAs are most frequently diagnosed in people aged 55 and older. People of Asian, African, or Caribbean descent are also at a higher risk of experiencing a TIA.

Several medical conditions are associated with an increased risk of TIA. These include:

• High blood pressure (hypertension)
• High cholesterol levels
• Diabetes
• Heart disease
• Atrial fibrillation or other types of irregular heartbeat
• Chronic kidney disease
• Sleep apnea
• A personal history of preeclampsia during pregnancy

Lifestyle factors can also contribute to the risk of experiencing a TIA. These include:

• Smoking
• Excessive alcohol consumption
• Sedentary lifestyle
• Obesity
• Lack of exercise
• Unhealthy diet

Additionally, people with a personal or family history of TIAs, strokes, or heart attacks are at a higher risk of experiencing a TIA.

It is important to recognize the warning signs of a TIA, as it can serve as a "warning stroke" indicating a possible full-blown stroke in the future. Common warning signals include the sudden onset of weakness, numbness, or paralysis on one side of the body, slurred speech, blindness, and severe headache. If any of these symptoms are present, it is crucial to seek immediate medical attention, even if the symptoms disappear, as quick treatment can reduce the risk of a future stroke.

Diagnosis and treatment of a TIA

A transient ischaemic attack (TIA) is a temporary blockage of blood flow to the brain, often referred to as a "mini stroke". The symptoms of a TIA are usually temporary and can last from a few minutes to up to 24 hours. However, it is important to get help immediately if you think you are experiencing a TIA, even if the symptoms disappear.

Diagnosis

The temporary nature of TIA symptoms can make diagnosis challenging. However, it is important to seek medical advice as soon as possible, ideally within 24 hours of the onset of symptoms. The diagnosis process typically includes:

• An assessment of symptoms and medical history.
• Imaging of the blood vessels in the head and neck.
• Further tests such as a head CT, angiography, or MRI scan.

Once a TIA is diagnosed, it is recommended to have a follow-up appointment with a neurologist to assess the risk of a future stroke.

Treatment

Although TIA symptoms usually resolve within a few minutes or hours, treatment is necessary to prevent another TIA or a full stroke in the future. Treatment depends on individual circumstances, such as age and medical history. It may include:

• Lifestyle changes to reduce the risk of a stroke.
• Medication to treat the cause of the TIA and prevent blood clots.
• In some cases, surgery (carotid endarterectomy) may be required to unblock the carotid arteries supplying blood to the brain.

Preventing a TIA

A transient ischaemic attack (TIA) is a temporary blockage of blood flow to the brain, often referred to as a "mini stroke". It is a warning sign that you may be at risk of having a full stroke in the near future. While a TIA doesn't cause permanent damage, it is important to seek medical attention immediately if you experience any symptoms, even if they disappear.

Maintain a Healthy Weight

It is important to stay within a healthy weight range. Being overweight can increase your risk of developing conditions such as high blood pressure, high cholesterol, and diabetes, which are all risk factors for TIA and stroke.

Eat a Healthy, Balanced Diet

Consuming a low-fat, high-fibre diet with plenty of fruits and vegetables, whole grains, and lean meats is recommended. Limit your salt and sugar intake, and avoid processed and high-cholesterol foods. An unhealthy diet can increase your risk of TIA by raising your blood pressure and cholesterol levels.

Exercise Regularly

Engaging in regular physical activity can help lower your cholesterol levels and keep your blood pressure in a safe range. It is recommended to get at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week. Strength exercises are also beneficial and should be done at least twice a week.

Avoid Smoking

Smoking significantly increases the risk of TIA and stroke by narrowing the arteries and making blood more likely to clot. Quitting smoking will not only reduce this risk but also improve your overall health and lower your chances of developing serious conditions such as lung cancer and heart disease.

Limit Alcohol Consumption

Excessive alcohol intake can lead to weight gain, high blood pressure, and irregular heartbeat, all of which are risk factors for TIA and stroke. It is recommended to drink in moderation and not exceed the weekly recommended limits of 14 units for both men and women.

Manage Underlying Conditions

If you have been diagnosed with conditions such as high cholesterol, high blood pressure, atrial fibrillation, or diabetes, it is crucial to control and treat these conditions effectively. This may involve lifestyle changes and taking prescribed medication to reduce your risk of TIA and stroke.

Frequently asked questions