Mini-stroke

Page last reviewed: 13/07/2011

A transient ischaemic attack (TIA), or 'mini-stroke', is caused by a temporary fall in the blood supply to part of the brain, leading to a lack of oxygen to the brain. This can cause symptoms that are similar to a stroke, although they don't last as long. A TIA lasts only a few minutes and is usually resolved within 24 hours.

The main signs and symptoms of a TIA can be remembered by the word FAST: Face-Arms-Speech-Time:

  • Face. The face may have fallen on one side, the person may not be able to smile, or their mouth or eye may have drooped.
  • Arms. The person with suspected stroke may not be able to raise both arms and keep them there, due to arm weakness or numbness. 
  • Speech. There may be slurred speech. 
  • Time. It is time to dial 999 immediately if you see any of these signs or symptoms.
    If signs and symptoms last longer than 24 hours, it is regarded as a full stroke.

How common are TIAs?

It's difficult to know exactly how common TIAs are, as many people who have TIA symptoms do not seek medical help. Approximately 2500 people are assessed in Ireland each year for TIA.

A TIA is a medical emergency

If you have the symptoms of a TIA, seek medical attention urgently. TIAs are a warning sign that further TIAs, or a full stroke, may occur soon.

Without treatment, there is a one in 10 chance that you will have a full stroke within four weeks of having a TIA. A stroke is a serious condition and can cause permanent disability. In some cases, strokes can be fatal. More than 2000 people die from stroke in Ireland each year.

As TIAs are serious; it is important that they are always investigated so that appropriate treatment can be given quickly. With treatment, the risk of a further TIA or a full stroke can be greatly reduced.

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.

Page last reviewed: 13/07/2011

Recognising the signs and symptoms of a TIA

You can remember the main symptoms of a transient ischaemic attack (TIA) by remembering the word FAST: Face-Arms-Speech-Time.

  • Face. The face may have fallen on one side, the person may not be able to smile, their mouth or eye may droop.
  • Arms. The person with suspected mini-stroke may not be able to raise both arms and keep them there because of arm weakness or numbness.
  • Speech. There may be slurred speech. 
  • Time. It is time to dial 999 immediately if you see one or more of these signs or symptoms.

It is important for everyone to be aware of these signs and symptoms. If you live with or care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

Symptoms in the FAST test identify most TIAs and strokes.

Other signs and symptoms include:

  • loss of vision or partial loss of vision typically in one eye only
  • dizziness
  • communication problems, difficulty talking and difficulty understanding what others are saying
  • problems with balance and co-ordination
  • difficulty swallowing
  • numbness/weakness, resulting in complete paralysis of one side of the body
  • loss of consciousness (in severe cases)

Other symptoms of mini-strokes (TIAs)

The symptoms of a TIA are temporary (transient) and should clear up within 24 hours of the attack. The duration of symptoms may vary, but they often disappear within one hour.

You should never delay calling 999 in the hope that the symptoms dissappear as treatment for stroke needs to start very quickly after the syptoms begin.

Different parts of your brain control different parts of your body, so the symptoms that you have after a TIA will depend on what part of your brain is affected.

In some cases, a TIA occurs before a full stroke, which can cause serious and permanent damage. Therefore, the sooner you get medical attention, the less likely you, or the person who has had a TIA, will experience another TIA or a stroke.

If you suspect that you or someone else is having a TIA, seek medical attention immediately. Call 999 and ask for an ambulance.

Even if the symptoms disappear while you are waiting for the ambulance to arrive, you (or they) should still go to hospital for an assessment.

After an initial assessment, you are very likely to be referred rapidly to hospital to receive a more in-depth assessment and, if necessary, for specialist treatment to begin.

 

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Numbness
Numbness refers to a lack of sensation in a part of the body.

Page last reviewed: 13/07/2011

Blocked blood vessels interrupt the brain's blood supply

Blood is supplied to your brain by two main blood vessels (carotid arteries) and two other blood vessels (vertebral arteries). These arteries branch off into a series of smaller blood vessels, which help to provide blood to every part of your brain.

During a transient ischaemic attack (TIA), one of the small blood vessels that supply your brain with oxygen-rich blood becomes clogged or blocked.

When a blockage in a blood vessel occurs, the blood flow to your brain is disrupted. With a TIA, the disruption passes quickly and the blood supply to your brain soon returns to normal. With a full stroke, the blood flow to your brain is disrupted for much longer. Without a constant supply of blood, your brain cells begin to die.

The blockage in your blood vessels is usually caused by a narrowing of the arteries or as a result of a blood clot that has formed elsewhere in the body and travelled the brain..

Atherosclerosis

Atherosclerosis is a common condition that causes the arteries to narrow. It occurs when plaque (fatty deposits) develop on the inner lining of your blood vessels. This can cause your blood vessels to become hardened, thickened and less elastic, making it more difficult for blood to flow through them.

Blood clots

A TIA can also occur as a result of a blood clot forming in a blood vessel and blocking the blood supply to your brain.

A blood clot may be caused by a number of factors, some of which are listed below.

  • Heart conditions, such as atrial fibrillation, which cause your heartbeat to be irregular, or congestive heart muscle disease in which your heart does not pump blood effectively. 
  • Blood conditions, such as leukaemia (cancer of the blood cells), sickle cell anaemia (an inherited blood disorder), high levels of fat in your blood (hyperlipidaemia), abnormally thickened blood (polycythaemia), or overproduction of platelets in your blood (thrombocyaemia).

Sometimes, a TIA can occur when a blood clot from a blood vessel in another part of your body moves into one of the arteries that supply blood to your brain. This is known as an embolism.

Haemorrhage

In very rare cases, a TIA can be caused by a small amount of bleeding in the brain. This is known as a haemorrhage.

Risk factors

A number of factors can increase your chances of having a TIA. Some factors, such as age and gender, are fixed (unchangeable). However, others can be changed. By making a number of alterations to your lifestyle, you may be able to reduce your risk of having a TIA. See the 'prevention' section for more information about how you can do this.

Fixed risk factors

Some of the fixed risk factors associated with TIA are outlined below.

Age

As you get older, your arteries begin to harden and narrow, increasing your risk of having a TIA. Most TIAs occur in people who are over 60 years old, but TIAs can occur at any age, including in children and young adults. 

Gender

Men have a greater risk of having a TIA compared with pre-menopausal women. However, the risk of TIA and stroke increases in postmenopausal women.
It is not fully understood why a woman's risk of having a TIA increases after the menopause. However, the female hormones oestrogen and progesterone are thought to play a role as they can affect the elasticity of your blood vessels. In menopausal women, oestrogen and progesterone levels fall, which may cause the blood vessels to become harder and less elastic. 

Ethnicity

South Asian, African or Caribbean people have an increased risk of developing high blood pressure and diabetes, therefore they have a greater risk of having a TIA.

Family history

If you have a family history of stroke or TIA, your risk of having a TIA is increased. However, the risk is relatively small, and having family members who have had a TIA will not necessarily mean that you will have one. 

Lifestyle risk factors

High blood pressure

High blood pressure, or hypertension, is the most powerful risk factor associated with TIA. Having high blood pressure puts extra strain on the blood vessels in your body, causing them to become narrowed or clogged. 

Weight and diet

Eating a poor diet that is high in saturated fat increases your risk of developing atherosclerosis. If there is too much salt in your diet, it is likely that your blood pressure will be elevated which, like atherosclerosis, is a major risk factor for TIA. Being overweight also puts your heart under strain, and weakens your blood vessels. 

Smoking

Smoking can double your risk of having a TIA or stroke. This is because the harmful chemicals in cigarette smoke cause the lining in the arteries to thicken, which makes your blood more likely to clot.

Stopping smoking is therefore one of the main ways that you can help to prevent a TIA or stroke. See the 'prevention' section for more information about how to give up smoking.

Medical conditions

Some medical conditions, such as type 1 diabetes can increase your risk of having a TIA. This is because type 1 diabetes causes high levels of glucose in the bloodstream, which increases the risk of developing atherosclerosis (the formation of fatty deposits in the blood vessels).

 

Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Haemorrhage
To haemorrhage means to bleed or lose blood.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHg.

Page last reviewed: 13/07/2011

If you, or someone you know, is displaying symptoms of a transient ischaemic attack (TIA) you should get medical assistance immediately. This will minimise the risk of a further TIA, or full stroke.

Initial assessment

TIAs are often over very quickly, so you may not have any symptoms by the time you see your GP or other health professional.

When you are being assessed, the health professional will ask you in detail about the symptoms that you had during the TIA. For example, they will need to know how long the symptoms lasted and how they affected you. This will help them to rule out other conditions which may have caused your symptoms.

Your GP or health professional may still need to do a neurological examination, even if you feel that your symptoms have gone. You will have to do a series of simple tasks to check skills, such as your power, sensation and co-ordination.

Referral

If your GP or health professional suspects that you have experienced a TIA, you should be referred urgently to a specialist for further testing.

You may either be referred to a geriatrician or neurologist (a doctor who specialises in treating conditions that affect the brain and spine), or a consultant who specialises in strokes. Some people may be referred to a specialist TIA clinic, which are available at some hospitals and GP clinics.

You should be referred to a specialist or TIA clinic within seven days of your TIA occurring. If you have had more than one TIA in a period of seven days, you should be seen immediately by a specialist.

Testing

Following a TIA, you may have a number of tests that are designed to check for any underlying factors or conditions that may have caused your mini-stroke. Some of these tests are listed below.

Blood tests

If you have had a TIA, you might need a series of blood tests, which may include:

  • a blood pressure test - your blood pressure will be checked because high blood pressure (hypertension) is a major risk factor for TIA and stroke
  • a blood clotting test - your blood clotting ability will be tested to check how 'thin' your blood is and how likely it is to clot
  • a cholesterol test - a serum cholesterol test may be used to check your cholesterol levels; if you have high cholesterol, you are at a greater risk of having a TIA or stroke.
  • a glucose test - your blood glucose level will be checked. High levels of glucose in the blood may mean that you have diabetes.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a test that measures the electrical activity of your heart using a number of adhesive electrodes, which are attached to your skin. An ECG can detect any abnormal heart rhythms, which may be a sign of conditions such as atrial fibrillation (see TIA - causes).

Chest X-ray

You may have a chest X-ray to help rule out any other health conditions.

Computerised tomography (CT) scan

A computerised tomography (CT) scan uses a series of X-rays to produce an image of the inside of your body. It can be used to check for other factors that may have caused your TIA, such as a haemorrhage or tumour. 

Magnetic resonance imaging (MRI) scan

Like a CT scan, a magnetic resonance imaging (MRI) scan produces an image of the inside of your body, but instead of using X-rays it uses a strong magnetic field and radio waves. An MRI scan may be able to give a more detailed image of the brain and blood vessels than a CT scan.

Ultrasound

An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your body. You are most likely to have an ultrasound scan of the carotid arteries in your neck in order to see if they are narrowed or blocked. This type of ultrasound scan is sometimes known as a Doppler scan or a Duplex scan.

Echocardiogram

You may have an echocardiogram to produce a picture of the heart to check for various forms of heart disease.

Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Page last reviewed: 13/07/2011

If you have had a transient ischaemic attack (TIA), you will need to have treatment to help prevent you from having another TIA, or a full stroke.

The treatment that you need will depend on your individual circumstances, such as your age and medical history. Your healthcare team can discuss the treatment options with you, and tell you about the possible benefits and risks.

To reduce the risk of further TIAs or stroke, you may be given medication or asked to make changes to your lifestyle. These are outlined in TIA - prevention. Some people may also need surgery as part of their TIA treatment.

Medication

Anti-platelet medication

Platelets are the cells in your blood, which help it to clot. When a blood vessel is damaged, platelets stick together to form a blood clot in order to prevent bleeding. Anti-platelet medicines work by reducing the ability of the platelets to stick together and form clots.

If you have had a TIA, it is likely that you will need to take anti-platelet medication.

The most commonly prescribed anti-platelet medicines for preventing a TIA are described below.

Aspirin and dipyridamole

Aspirin is the most commonly prescribed anti-platelet. It is often taken along with another anti-platelet medicine called dipyridamole. Aspirin and dipyridamole are often prescribed together because they are more effective at preventing TIA and stroke when they are used in combination compared to when taken separately.

Following a TIA, you will usually be prescribed aspirin and dipyridamole for two years. After this time, you may be able to stop taking dipyridamole and take a low-dose of aspirin instead. You may have to take low-dose aspirin indefinitely, depending on what your GP thinks is the best treatment for you.

Taking a daily, low dose of aspirin is thought to reduce your risk of a TIA by 25%. It can also reduce your risk of a heart attack.

Side effects of aspirin may include:

  • irritation of your stomach
  • indigestion
  • nausea

Side effects of dipyridamole may include:

  • headaches 
  • dizziness
  • nausea 
  • diarrhoea

Clopidogrel

Clopidogrel is another anti-platelet medicine that is normally only prescribed if:

  • you have severe side effects from taking aspirin
  • you have had a further TIA, despite taking aspirin
  • you have arterial disease

Side effects of clopidogrel may include:

  • diarrhoea 
  • abdominal pain
  • indigestion
  • bruising 
  • bleeding

Anti-coagulant medication

Anti-coagulant medicines work by reducing the level of certain chemicals in your blood that are needed to help the blood to clot.

You are normally only prescribed an anti-coagulant medicine if the blood clot that caused your TIA originated from your heart. This is often due to a condition that is known as atrial fibrillation (see TIA - causes).

Warfarin

Warfarin is the anti-coagulant medicine that is used to help prevent further TIAs.

The dosage of warfarin that you receive must be enough to ensure that the blood is 'thinner' (less able to clot), but not so thin that it causes problems such as internal bleeding.

Because having the correct dosage of warfarin is so important, your condition will be carefully monitored while you are taking the medication. You will need to have regular blood tests, known as international normalised ratio (INR) tests.

An INR test measures how long it takes your blood to clot. Your warfarin dosage may have to be adjusted after an INR test to ensure you are getting the right amount.

Bleeding is the most serious side effect of warfarin. If you notice any of the following symptoms when taking warfarin, seek medical attention immediately:

  • passing blood in your urine or faeces
  • passing black faeces
  • severe bruising
  • prolonged nosebleeds (lasting longer than 10 minutes)
  • blood in your vomit
  • coughing up blood
  • unusual headaches
  • in women, heavy or increased bleeding during your period, or any other bleeding from your vagina.

High blood pressure medication

If you have high blood pressure (hypertension), TIA - causes you may have to take medication to control it. This is because high blood pressure greatly increases your risk of having a TIA or stroke (see ).

There are lots of different types of medicine which can help to manage your blood pressure. Your GP will advise you about which one is most suitable for you. In order to be effective, some people have to take a combination of two or three different blood pressure medicines. 

Cholesterol medication

High cholesterol is another factor which may increase your risk of having a TIA. You can help to lower your cholesterol by making a number of lifestyle changes, such as eating a healthy, balanced diet. See TIA - prevention for more information about making lifestyle changes.

If your cholesterol needs to be lowered with medication, you will normally be prescribed a type of medicine known as a statin. Statins help to reduce the production of cholesterol in the liver.

Surgery

Carotid endarterectomy

A carotid endarterectomy is an operation that involves removing part of the lining of the damaged carotid artery, plus any blockage that has built up in the artery.

The carotid arteries deliver blood to your brain. When fatty deposits build up inside the carotid arteries, they become hard and narrow, making it more difficult for blood to flow through them. This is known as atherosclerosis (see TIA - causes ).

If you have atherosclerosis, you may need to have a carotid endarterectomy in order to help reduce your risk of having a further TIA or stroke.

A carotid endarterectomy is not suitable for everyone with atherosclerosis. For example, if your arteries are almost completely blocked, a carotid endarterectomy is unlikely to work. If you only have a partial blockage in your carotid arteries, you may also be unsuitable for this type of surgery because your risk of having a stroke during the procedure may outweigh the potential benefits of surgery.

A carotid endarterectomy is most suitable for people who have a moderate to severe blockage in their arteries. In such cases, the endarterectomy can cut the risk of further strokes occurring by more than a half.

Anticoagulant
Anticoagulant is a substance that stops blood from clotting (prevents coagulation). For example warfarin.
Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Platelets
Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.

Page last reviewed: 13/07/2011

<_o3a_p>

A transient ischaemic attack (TIA) often occurs without warning. Having a TIA is a sign that another one may follow. Further TIAs may have more serious effects, or develop into a full, life-threatening, stroke.

Whether or not you have previously had a TIA or stroke, you can lower your risk of having a future TIA or stroke in a number of ways. These are outlined below.

Weight

If you are overweight, your risk of having a TIA or stroke is increased. Being overweight also increases your risk of developing high blood pressure (hypertension), heart disease and diabetes. Losing excess weight will reduce your chances of having a TIA or stroke.

Exercise

Regular exercise can lower your blood pressure, which will help to prevent many potentially life-threatening conditions, including stroke, heart disease and cancer. It is also an effective way of maintaining a healthy weight, and it can combat stress and depression.

Aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.

Want to know more

See healthpromotion.ie

 

Healthy eating

Eating a healthy, balanced diet will help you lose any excess weight. It will also help keep your arteries healthy.

Make sure that you eat plenty of fruit and vegetables (at least five portions a day) as they are a great source of essential vitamins and minerals.

Fruit and vegetables also contain substances called anti-oxidants, which reduce the risk of stroke by protecting the walls of your blood vessels from damage.

Limit the amount of salt that you eat to no more than 6g a day. Too much salt can increase your blood pressure, which increases your risk of TIA and stroke. Do not add salt to your food, and be aware that lots of processed foods include 'hidden' salts. Therefore, always check the nutritional information on the label before buying food products. 

Limiting the amount of saturated fats in your diet will help to keep your cholesterol under control. Foods that are high in saturated fats include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods containing coconut or palm oil

If you eat a lot of fatty foods, your arteries are more at risk of getting clogged up with the fatty deposits (plaques).

Alcohol

Drinking too much alcohol may increase your risk of having a TIA or stroke. Therefore, try to stay within the recommended limits of alcohol.

Low risk weekly guidelines for adults are:

  • up to 11 standard drinks in a week for women, and
  • up to 17 standard drinks in a week for men.
<_o3a_p>

If you have had a TIA, you will not need to cut out alcohol altogether. Some studies have suggested that drinking a small amount of alcohol (within the recommended daily amount) may actually reduce your risk of having a TIA or stroke. This is because alcohol can thin the blood.

However, always avoid binge drinking. Drinking too much alcohol is likely to raise your blood pressure. It also raises the risk of a blood vessel bursting and causing bleeding into your brain. This, in turn, will increase your risk of having a TIA or stroke.

Stop smoking

Smoking doubles your risk of having a stroke. This is because it narrows your arteries and makes your blood more likely to clot.

If you stop smoking, you can reduce your risk of having a stroke by up to half. Quitting smoking will also improve your general health and reduce your risk of developing other, serious conditions, such as lung cancer and heart disease.

Visit www.quit.ie for information and support releting to quiting smoking

Want to know more?

Cholesterol
Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z