Spotting Mini Strokes: Signs And Symptoms To Know

how can amini stroke be detected

A mini stroke, or transient ischaemic attack (TIA), occurs when there is a temporary disruption in the blood supply to the brain, resulting in a lack of oxygen. This can cause sudden symptoms similar to those of a stroke, such as changes in alertness, sensory changes, mental changes, muscle weakness, dizziness, and sensation problems. As the symptoms of a TIA are the same as those of a stroke, it is important to be assessed by a healthcare professional as soon as possible if you think you or someone else is having a TIA. The diagnosis of a TIA can be challenging and often depends on a detailed history-taking, as symptoms may have resolved by the time of the assessment. However, certain clinical and demographic features can help distinguish TIAs from other conditions. This includes negative symptoms characterised by loss of function, such as motor, sensory, and visual symptoms, as well as speech disturbances. Detecting a mini stroke is crucial as it serves as a warning sign of a potential full stroke in the future, often in the near term.

Characteristics Values
Duration A few minutes to 24 hours
Symptoms Change in alertness, changes in senses, mental changes, muscle problems, dizziness, loss of balance and coordination, lack of control over bladder or bowels, sensation problems, loss of motor function, speech disturbance, ataxia, diplopia, vertigo, positive symptoms, negative symptoms, confusion, amnesia, headache, bowel or bladder symptoms, generalised weakness
Tests Blood pressure tests, blood tests, electrocardiogram (ECG), carotid ultrasound scan, brain scans (MRI or CT), angiogram, echocardiogram, carotid duplex ultrasound, heart rhythm monitoring tests, EEG test

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Transient ischemic attack (TIA)

A transient ischemic attack (TIA), often referred to as a "mini-stroke", is a temporary blockage of blood flow to the brain. The clot usually dissolves on its own or gets dislodged, and the symptoms usually last less than five minutes, and up to 24 hours. While a TIA doesn't cause permanent damage, it's a "warning stroke", signalling a possible full-blown 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

There's no immediate way to tell whether symptoms are from a TIA or a stroke, so it's important to seek emergency medical care right away. Quick evaluation from a doctor can help identify the cause and how to treat it. Diagnosis is challenging because symptoms can disappear within an hour, and there is no established biomarker for TIA.

After an initial assessment, a patient will be referred to a specialist for further tests to determine the cause of the TIA. This usually happens within 24 hours of the start of symptoms. The specialist will ask about the symptoms experienced and how long they lasted to rule out other conditions. Several tests may be done to confirm a TIA, including blood pressure tests, blood tests, an electrocardiogram (ECG), a carotid ultrasound scan, and a brain scan (usually an MRI).

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MRI and CT scans

Magnetic resonance imaging (MRI) and computerised tomography (CT) scans are two of the most effective diagnostic tests for strokes. They allow doctors to clearly view the head, including the tissue and blood vessels. Both types of scan can be used to determine whether a stroke is hemorrhagic (caused by a burst blood vessel) or ischemic (caused by a blocked blood vessel).

CT Scans

CT scans use X-rays and computers to create multiple images of the inside of the head from various angles. They can show the size and location of any abnormalities in the brain, such as tumours or blood clots, as well as infections and areas of dead tissue. CT scans are particularly effective at detecting hemorrhagic strokes, as they can identify the presence of bleeding. They are also useful for ruling out other conditions that may be causing stroke-like symptoms, such as brain tumours.

CT scans are usually the first choice for urgent imaging as they are faster than MRIs, with results available on the same day, and more widely available in hospitals. They also have the advantage of being able to use contrast dye to highlight blood vessels. However, CT scans do not provide the same level of detail as MRIs and cannot always find the location of a blood clot.

MRI Scans

MRI scans use magnetic fields, radiofrequency pulses and computers to reveal any changes in the brain. They can uncover brain damage within an hour of the onset of stroke symptoms and are highly sensitive, meaning they can detect even tiny abnormalities. They can also be used to assess the extent and severity of a stroke, as well as to monitor progress and determine if there are any complications or recurrent strokes.

MRI scans do not use radiation and are therefore considered very safe. However, they are not suitable for people with metallic or electronic implants, and the longer duration of the procedure may be an issue for people with claustrophobia.

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Risk factors

Transient ischemic attacks (TIAs) are often referred to as "mini-strokes", but this term is misleading as they are just as serious as full-blown strokes and can be a precursor to one occurring in the near future. 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.

There are several risk factors that can increase the likelihood of experiencing a TIA or stroke. These can be broadly categorised into medical conditions and lifestyle choices.

Medical Conditions

  • Previous stroke or TIA: If you have already experienced a stroke or TIA, your chances of having another one are higher.
  • High blood pressure: This is a leading cause of strokes and TIAs. Lowering blood pressure through lifestyle changes or medication can reduce your risk.
  • Heart disorders: Common heart problems such as coronary artery disease, heart valve defects, irregular heartbeat (including atrial fibrillation), and enlarged heart chambers can increase the risk of blood clots, which may lead to a stroke.
  • Diabetes: Diabetes causes a buildup of sugars in the blood, preventing oxygen and nutrients from reaching the brain. People with diabetes often also have high blood pressure, which further increases the risk of stroke.
  • Obesity: Being overweight or obese is linked to higher levels of "bad" cholesterol and triglycerides, as well as lower levels of "good" cholesterol. Obesity can also contribute to high blood pressure and diabetes, both of which are risk factors for stroke.
  • Sickle cell disease: This blood disorder, which primarily affects Black children, can cause a stroke if sickle-shaped red blood cells block blood flow to the brain.

Lifestyle Choices

  • Diet: Consuming a diet high in saturated fats, trans fat, and cholesterol is linked to an increased risk of stroke and related conditions such as heart disease. Excess salt (sodium) in the diet can also raise blood pressure levels.
  • Physical inactivity: Lack of physical activity can lead to health conditions that raise the risk of stroke, including obesity, high blood pressure, high cholesterol, and diabetes. Regular exercise can lower your chances of experiencing a stroke.
  • Alcohol consumption: Drinking excessive alcohol can increase blood pressure and triglyceride levels, hardening your arteries and raising the risk of stroke. It is recommended that women have no more than one drink per day, and men should limit themselves to no more than two drinks per day.
  • Tobacco use: Smoking or vaping increases the risk of stroke by damaging the heart and blood vessels, as well as raising blood pressure. Exposure to secondhand smoke also increases the likelihood of having a stroke.
  • Age: The risk of experiencing a stroke or TIA increases with age. Stroke rates double every 10 years after the age of 55.

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Symptoms

A mini stroke, or transient ischaemic attack (TIA), occurs when there is a temporary disruption in the blood supply to the brain. This disruption results in a lack of oxygen to the brain, causing sudden symptoms akin to those of a stroke. However, unlike a stroke, the effects of a TIA only last a few minutes or hours and fully resolve within 24 hours.

Face

  • The face might droop on one side.
  • The person may not be able to smile.
  • The mouth may have drooped, and the eyelid may droop.

Arms

The person may experience arm weakness or numbness in one arm and be unable to lift both arms.

Speech

  • Speech may be slurred or garbled.
  • The person may be unable to talk, even though they appear awake.

Other symptoms include:

  • Complete paralysis of one side of the body.
  • Sudden loss or blurring of vision.
  • Difficulty understanding what others are saying.
  • Problems with balance and coordination.
  • Change in alertness (including sleepiness or unconsciousness).
  • Mental changes (such as confusion, memory loss, difficulty writing or reading).
  • Muscle problems (such as weakness, trouble swallowing, or trouble walking).
  • Dizziness or loss of balance and coordination.
  • Lack of control over the bladder or bowels.
  • Sensation problems (such as numbness or tingling on one side of the body).

It is important to note that a person experiencing a TIA may not exhibit all of these symptoms, and the symptoms can appear suddenly, usually over a few seconds. If you or someone else is experiencing any of these symptoms, seek immediate medical attention by calling an emergency number.

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Treatment

A transient ischemic attack (TIA) or "mini stroke" is a temporary blockage of blood flow to the brain, usually caused by a blood clot. While a TIA doesn't cause permanent damage, it is a "warning stroke" signalling a possible full-blown stroke in the future. It is therefore important to seek immediate medical attention if you experience any symptoms of a TIA.

If you spot any of the signs of a TIA, call emergency services immediately. You should be taken to the hospital to receive a comprehensive evaluation, which should ideally be done within 24 hours of the onset of symptoms. The evaluation will include an assessment of symptoms and medical history, imaging of the blood vessels in the head and neck, and other tests such as a head CT, angiography, and MRI.

Once a TIA is diagnosed, a follow-up visit with a neurologist is recommended to assess your risk of a future stroke and determine the appropriate treatment plan. Treatment will depend on your individual circumstances, such as your age and medical history.

You will likely be given advice about lifestyle changes you can make to reduce your risk of a stroke, such as maintaining a healthy weight, eating a healthy and balanced diet, and doing regular exercise. You may also be offered medication to treat the cause of the TIA, such as aspirin or other blood-thinning medications to prevent blood clots.

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 your brain with blood.

Frequently asked questions

A mini-stroke, or transient ischaemic attack (TIA), happens when there is a temporary disruption in the blood supply to the brain. This can be caused by a blood clot or an injury to blood vessels. The effects of a TIA usually last a few minutes to a few hours and fully resolve within 24 hours.

The symptoms of a mini-stroke are the same as those of a stroke and can be remembered with the acronym FAST:

- Face: the face might drop on one side, the person may not be able to smile, their mouth may have drooped, and their eyelid may droop.

- Arms: the person may not be able to lift both arms due to weakness or numbness in one arm.

- Speech: their speech may be slurred or garbled, or they may be unable to talk at all.

- Time: it is time to call emergency services if you see any of these signs or symptoms.

Other symptoms may include complete paralysis of one side of the body, sudden loss or blurring of vision, difficulty understanding speech, and problems with balance and coordination.

A mini-stroke is a medical emergency, so it is important to call emergency services immediately. Do not wait to see if the symptoms pass, as the risk of a full stroke is highest in the days and weeks after a mini-stroke.

If you suspect you have had a mini-stroke, it is important to see a healthcare professional as soon as possible for an assessment, even if your symptoms have disappeared. They will ask you about your symptoms and may perform a neurological examination to check your strength, sensation, and coordination skills. They may also refer you to a specialist for further tests, such as blood tests, brain scans, and heart monitoring.

A mini-stroke is a warning sign that you are at risk of having a full stroke in the future, so it is important to seek urgent medical help. If you do not receive treatment, you may have another mini-stroke or a full stroke.

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