Transient ischemic attacks are associated with an elevated risk for a full-blown stroke, and the risk factors and symptoms of both conditions are identical, with prompt medical evaluation needed
CLEVELAND, Ohio: ‘Mini-strokes’, medically known as transient ischemic attacks (TIA) produce symptoms only temporarily and cause no permanent neurological damage, but should be viewed as a warning shot in advance of a full-blown ischemic stroke, says an expert from global health system Cleveland Clinic ahead of World Stroke Day on October 29.
Vascular Neurologist Zeshaun Khawaja, MD MBA explains that in a TIA, blood flow to the brain is temporarily interrupted, causing a variety of sudden stroke-like symptoms that usually subside within minutes, although sometimes they may take hours to resolve completely.
“The term ‘mini-stroke’ is a bit misleading as it doesn’t convey the seriousness of the event,” says Dr. Khawaja. “TIAs may cause temporary symptoms but they signal an elevated risk of future stroke, which can lead to long term disability or death. Because of this, anyone who experiences a TIA should seek immediate medical attention to ensure proper evaluation and treatment of risk factors that can elevate the risk of stroke.”
According to Dr. Khawaja, “It is estimated that an individual’s risk of stroke after TIA can be as high as 5% within 48 hours and 10% within 90 days. TIAs, stroke, and cardiovascular disease share many of the same risk factors so addressing a TIA could reduce the risk of other cardiovascular events in the future.”
According to the World Stroke Organization, globally one in four adults over the age of 25 will have a stroke in their lifetime. In addition, 12.2 million people worldwide will have their first stroke this year and 6.5 million will die as a result.
Dr. Khawaja says that it is important for all individuals, but particularly those who have had a TIA, to have regular health checkups so that elevated risks for stroke can be identified and addressed early. “Many patients don’t have a TIA before a stroke, so knowing and controlling your risk factors is the best way to prevent strokes,” he says.
Among the modifiable risk factors are high blood pressure, high cholesterol, diabetes, atrial fibrillation, obesity, a sedentary lifestyle, smoking, heavy alcohol use, drug use, and sleep apnea. In addition to addressing these factors, a patient at risk of stroke might be prescribed medications to manage the risks, for example to lower blood pressure, blood sugar and cholesterol or to thin the blood.
Symptoms of a stroke and TIA
The symptoms of a TIA are identical to a stroke, so it is vital to seek immediate medical attention if they arise. Dr. Khawaja says, “While the symptoms are occurring, it’s impossible to distinguish if you’re having a TIA or a stroke. We can’t call it a TIA until the symptoms resolve, and you cannot afford to wait for symptoms to resolve as you risk losing around 2 million brain cells every minute.”
He adds, “Stroke is a medical emergency. In an ischemic stroke, blood flow to the brain is interrupted, usually because of a clot, and can result in irreversible brain cell death after just a few minutes, so every minute counts. If you’re exhibiting TIA or stroke symptoms, call emergency services and get evaluated right away.”
Dr. Khawaja says the urgency is summed up in the mnemonic used to remember stroke or TIA symptoms, ‘BE FAST’, where the letters stand for:
- Balance – a sudden loss of balance;
- Eyes – sudden loss of vision or double vision;
- Face – one side of the face droops or feels numb;
- Arms – arm and/or leg weakness and/or numbness usually on one side of the body;
- Speech – slurred words, difficulty producing or understanding speech; and
- Time – acting immediately and calling emergency services if one or more of the symptoms above are present.
Dr. Khawaja points out that administration of clot-busting medications or the removal of a clot through endovascular procedures must occur immediately to reduce the risk of long-term disability. Waiting, particularly longer than 4.5 hours from symptom onset, may exclude using a clot buster or other treatments. He advises patients not to chew an aspirin in an attempt to thin their blood as they wait for an ambulance. This is because the stroke might be the result of bleeding on the brain, rather than a clot, in which case a blood thinner may make the situation worse.
Lifelong, aggressive management
“If you are diagnosed with a TIA or stroke, it’s important to be very aggressive in managing your risk factors,” Dr. Khawaja concludes. “Stroke is highly preventable and it continues to be a leading cause of disability and death worldwide. Everyone should have regular follow-up consultations with their doctors to ensure all of their risk factors are well controlled. Also, don’t underestimate the importance of a healthy lifestyle to prevent stroke.”
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 72,500 employees worldwide are more than 5,050 salaried physicians and researchers, and 17,800 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,500-bed health system that includes a 173-acre main campus near downtown Cleveland, 22 hospitals, more than 220 outpatient facilities, including locations in northeast Ohio; southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2021, there were 10.2 million total outpatient visits, 304,000 hospital admissions and observations, and 259,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org.
