Understanding Multiple Mini Strokes: What You Need To Know

Experiencing a stroke can be life-altering, and it is understandable that a survivor's greatest fear is having another one. The risk of a second stroke is elevated, and it is crucial to understand the factors that may have caused the initial stroke to reduce the chances of recurrence. Transient ischemic attacks (TIAs), often called mini-strokes, are temporary interruptions of blood flow to the brain and should be treated as a medical emergency. While the effects of a TIA may resolve within 24 hours, it significantly increases the risk of a full-blown stroke in the near future. Therefore, seeking immediate medical attention and making necessary lifestyle changes are vital to preventing a second stroke.

Transient ischemic attack (TIA)

Transient ischemic attacks (TIAs) are often incorrectly called “mini-strokes". However, they are just as serious as a full-blown stroke. A TIA is a temporary blockage of blood flow to the brain, usually lasting less than five minutes, and the symptoms go away within 24 hours. While a TIA doesn’t cause permanent damage, it’s a “warning stroke” signalling a possible major stroke ahead.

TIA symptoms are similar to those of a stroke and usually happen suddenly. They 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
• Problems with walking, dizziness
• Difficulty talking or understanding speech
• Loss of balance and coordination
• Weakness, numbness or paralysis on one side of your body
• Slurred speech or difficulty understanding others
• Blindness in one or both eyes
• Severe headache with no apparent cause

Anyone can have a TIA, but the risk increases with age. Stroke rates double every 10 years after age 55. If you’ve previously had a stroke or a TIA, you are at a higher risk of having another one. Major risk factors for a TIA or stroke include:

• High blood pressure
• Diabetes
• Heart disease
• Atrial fibrillation
• Smoking
• Heavy alcohol use
• Overweight and obesity
• High cholesterol

If you think you are having a TIA, get emergency medical care right away. A doctor can diagnose a TIA based on a person’s symptoms and medical history. They will do a physical exam to check for heart and blood vessel problems as well as muscle and nerve issues. Imaging tests of the brain like an MRI or CT scan may also be ordered.

It is important to take a TIA as seriously as a major stroke. About 80 percent of recurrent strokes may be prevented by making healthy lifestyle changes such as controlling blood pressure and cholesterol, taking medication, and exercising.

Risk factors for stroke

There are many risk factors for stroke, some of which can be changed or controlled, and some that cannot. The best way to protect yourself and your loved ones from a stroke is to understand your risk and how to control it.

Factors beyond your control

• Age: The older you are, the more likely you are to have a stroke. The chance of having a stroke doubles every ten years after the age of 55. However, it's important to note that stroke can occur at any age, and about one in seven strokes occur in adolescents and young adults aged 15 to 49.
• Family history and genetics: Your risk of having a stroke is higher if a parent or other family member has had a stroke, especially at a younger age. Certain genes, such as those that determine your blood type, can also affect your stroke risk. People with blood type AB have a higher risk.
• Sex: While men are more likely to have a stroke at younger ages, women tend to live longer, so their lifetime risk of having a stroke is higher. Additionally, women who take birth control pills, use hormone replacement therapy, or are pregnant are at an increased risk.
• Race and ethnicity: In the United States, stroke occurs more frequently in Black, Alaska Native, American Indian, and Hispanic adults compared to White adults.

Lifestyle factors you can control

• High blood pressure: High blood pressure, or hypertension, is one of the leading causes of stroke. Lowering your blood pressure through lifestyle changes or medication can significantly reduce your risk of having a stroke.
• Cholesterol: High cholesterol levels can lead to a buildup of cholesterol in the arteries, including those in the brain, which can result in a blockage and increase the risk of stroke.
• Heart conditions: Common heart disorders, such as coronary artery disease, heart valve defects, irregular heartbeat (atrial fibrillation), and enlarged heart chambers, can increase the risk of blood clots, which may cause a stroke.
• Diabetes: Diabetes can cause a buildup of sugars in the blood, preventing oxygen and nutrients from reaching the brain. Additionally, people with diabetes often have high blood pressure, which further increases the risk of stroke.
• Obesity: Obesity is linked to higher levels of "bad" cholesterol and triglycerides, as well as lower levels of "good" cholesterol. It can also contribute to high blood pressure and diabetes, both of which are risk factors for stroke.
• Diet: Consuming a diet high in saturated fats, trans fat, and cholesterol has been linked to stroke and related conditions, such as heart disease.
• Physical inactivity: Lack of physical activity can lead to health conditions that increase the risk of stroke, including obesity, high blood pressure, high cholesterol, and diabetes. Regular physical activity can lower your chances of having a stroke.
• Alcohol consumption: Drinking excessive alcohol can raise blood pressure levels and increase the risk of stroke. It also increases triglyceride levels, a form of fat that can harden arteries.
• Tobacco use: Tobacco use, including smoking and vaping, increases the risk of stroke by damaging the heart and blood vessels. Nicotine raises blood pressure, while carbon monoxide from cigarette smoke reduces the amount of oxygen in the blood.
• Other substance use: Illegal drug use, such as cocaine, and overuse of alcohol, have been linked to an increased risk of stroke.

Social and environmental factors

• Social determinants of health: Factors such as living in a poor or rural area, having low education or income levels, and lacking health insurance can impact your risk of stroke.
• Air pollution: Living or working in areas with air pollution has been identified as a contributing factor to stroke risk.

Previous stroke or transient ischemic attack (TIA)

It is important to note that having a previous stroke or TIA, also known as a "mini-stroke," significantly increases your chances of having another stroke. Therefore, it is crucial to address and manage these risk factors to prevent future strokes.

Preventing a second stroke

Yes, it is possible to have more than one mini-stroke, or transient ischemic attack (TIA). In fact, having a TIA means you are likely to have a stroke in the near future. Therefore, it is important to take a TIA as seriously as a major stroke and seek immediate medical attention.

Having a stroke puts you at a higher risk of experiencing a second one. However, many recurrent strokes can be prevented by making some lifestyle changes and following your doctor's recommendations. Here are some ways to help prevent a second stroke:

• Manage High Blood Pressure: High blood pressure, or hypertension, is one of the leading causes of stroke. Taking prescribed medications to control blood pressure can significantly reduce the risk of a second stroke.
• Take Prescribed Medications: It is important to take any prescribed medications as instructed by your doctor. This includes medications to control blood clotting, cholesterol, or diabetes.
• Healthy Diet: Adopting a healthy diet, such as the Mediterranean diet, can lower the risk of stroke. This includes consuming more fruits and vegetables, white meats, and whole grains, while reducing red meats, bread, and carbohydrates.
• Exercise: Regular physical activity is key to reducing the risk of a second stroke. Aim for at least 10 minutes of moderate-intensity aerobic activity four times a week or 20 minutes of vigorous-intensity activity twice a week.
• Quit Smoking: Smoking increases the risk of stroke and various types of cancer. Quitting smoking can significantly lower your risk of having another stroke.
• Manage Weight: Maintaining a healthy weight can help reduce your risk of stroke.
• Manage Chronic Conditions: It is important to work with your doctor to manage any chronic conditions such as diabetes, high blood pressure, or high cholesterol.
• Support Network: Family and friends can provide support for lifestyle changes, medication adherence, and quitting smoking.

Warning signs of a stroke

Transient ischemic attacks (TIAs), or "mini-strokes", are a serious warning sign that a full-blown stroke may occur in the near future. It is a medical emergency and should not be ignored. It is important to act F.A.S.T. (or B.E. F.A.S.T.) and call 911 if you or someone you know is experiencing the following:

• Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
• Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence.
• Time to call 911 – Stroke is an emergency. Every minute counts. Call 911 immediately. Note the time when any of the symptoms first appear.

Other warning signs of a stroke include:

• Numbness or weakness of the face, arm, or leg, usually on one side of the body
• Trouble speaking or understanding
• Problems with vision, such as dimness or loss of vision in one or both eyes
• Dizziness or problems with balance or coordination
• Problems with movement or walking
• Severe headaches with no known cause, especially if they happen suddenly
• Sudden nausea or vomiting not caused by a viral illness
• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma

Treatments for stroke

The treatment for a stroke depends on the type of stroke you've had. However, some general treatments include medicines, surgery, and procedures.

Medicines

If you have had an ischemic stroke, you may be given a thrombolytic (a "clot-busting" drug) to break up blood clots. Tissue plasminogen activator (tPA) is a commonly used thrombolytic. Other medicines used to treat ischemic strokes include blood thinners and cholesterol-lowering medications such as statins. Anticoagulants are also often prescribed long-term to prevent blood clots from forming.

Surgery

In some cases, surgery may be required to remove a blood clot (thrombectomy) or drain fluid from the brain. If the stroke is caused by a ruptured aneurysm, a metal clip may be surgically placed to stop the blood loss.

Procedures

Endovascular procedures are often used to treat hemorrhagic strokes. These procedures involve threading thin, tube-like devices into the blood vessels through small incisions in the skin. Angioplasty, which involves widening narrowed arteries with a catheter that has a balloon attachment, is one such procedure. Stenting, which involves placing a mesh scaffold-like device inside a blood vessel to hold it open, is another option.

Lifestyle Changes

In addition to medical treatments, it is important to make lifestyle changes to prevent future strokes. These include increasing physical activity, improving diet, managing blood pressure, getting healthy sleep, and quitting smoking.

Frequently asked questions