Neurology
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Have you ever heard of a “ministoke” or TIA and wondered what exactly these terms mean? There’s often confusion about these conditions, even in how they’re named. Understanding the differences between transient ischemic attacks (TIA) and actual strokes could potentially save your life or the life of someone you love.
Mount Nittany Health Neurologist, Dr. Pete Roy, shares his experience and expertise on TIAs.
What is a TIA, and how does it differ from a stroke?
From a neurological perspective, a transient ischemic attack and what people often call a “ministroke” are not the same thing. Though they are frequently used interchangeably.
A TIA is defined as temporary neurological symptoms that resolve completely without evidence of brain damage on imaging tests like CT scans or MRIs. In other words, blood flow to part of your brain is temporarily interrupted, causing stroke-like symptoms, but no permanent damage occurs.
“A TIA is a sudden onset of transient neurologic symptoms of the brain, spinal cord, or retina, without actual tissue injury seen on imaging studies such as MRI; therefore, no actual stroke,” Dr. Roy explained. “These episodes tend to be relatively brief, typically lasting less than 60 minutes (but may be longer). The key is no actual stroke on the imaging studies.”
“Many patients with TIAs have an increased risk of actual stroke in the first 48 hours,” he added.
In contrast, what some people call a “ministroke” is actually a small stroke that shows up on brain imaging as tissue damage. Many small strokes may occur without noticeable symptoms (called “silent strokes”) and appear as small white matter spots on MRI scans.
The most important takeaway: Whether symptoms are from a TIA or a small stroke can’t be determined without proper medical evaluation and imaging. This is why even brief neurological symptoms require emergency medical attention.
Recognizing the warning signs
The symptoms of a TIA are identical to those of a stroke, but they’re temporary. Remember the acronym BE FAST to identify common warning signs.
- Balance: Sudden loss of balance, coordination, or dizziness
- Eyes: Sudden trouble seeing in one or both eyes
- Face: Sudden drooping or numbness on one side of the face
- Arm: Sudden weakness or numbness in one arm or leg
- Speech: Sudden difficulty speaking or understanding speech
- Time: Time to call 911 immediately
Other symptoms may include:
- Sudden severe headache with no known cause
- Confusion or difficulty understanding
These symptoms typically last less than an hour with TIAs, but that doesn’t mean they’re less serious. They serve as critical warning signs.
Why TIAs are serious warning signs
TIAs might not cause permanent damage, but they indicate a serious underlying condition that requires immediate medical attention. They often signal a high risk for a future stroke.
“Statistically, patients with TIAs are at increased risk for stroke, particularly in the first 48 hours after the event,” Dr. Roy explained. “Neurologists use a scale to help clarify risk. This is the ACBD2 scale.”
The ABCD2 scale evaluates the patient’s age, blood pressure readings, specific symptoms experienced, how long those symptoms lasted, and whether the person has diabetes. This scoring system helps doctors identify which patients are at highest risk for experiencing a full stroke shortly after a TIA.
“If the point total is 6-7, there is an 8.1% chance of stroke in the first 48 hours after a TIA,” he continued. “There is a 4.1% chance if the point total is 4-5. 2-3 points is a 1.3% chance of stroke in the first 48 hours, and 0-1 points is virtually no risk for a subsequent stroke in the first 2 days.”
“In addition, there is a 20% risk of stroke within the first 3 months of a TIA, and the majority of this is within the first few days,” he added.
This is why medical professionals take TIAs very seriously—they represent a critical opportunity to prevent a potentially devastating stroke.
Risk factors and causes
TIAs typically occur when blood flow to part of the brain is temporarily blocked. This usually happens due to:
- Blood clots: Either forming in the brain arteries or traveling from elsewhere in the body
- Narrowed arteries: Due to plaque buildup (atherosclerosis)
- Small vessel disease: Affecting the tiny blood vessels within the brain
Factors that increase your risk include:
Factors you cannot control
- Age—risk increases after 60
- Family history of stroke or TIA
- Previous TIA or stroke
Factors you can control
- High blood pressure
- Smoking
- Diabetes
- High cholesterol
- Physical inactivity
- Obesity
- Excessive alcohol consumption
- Unhealthy diet
Diagnosis and evaluation
When you arrive at the emergency department with possible TIA symptoms, healthcare providers perform a comprehensive evaluation to determine whether you’ve had a TIA or a small stroke.
“Just about everyone who comes to the emergency room with a TIA will get a full stroke workup and have their stroke risk assessed and treated,” Dr. Roy explained. “We take TIAs very seriously. Transient neurologic symptoms could actually represent something serious going on from a neurovascular standpoint.”
“In addition, an actual stroke may be present even though the symptoms resolved quickly,” he continued. “We are aggressive in looking at the arteries of the head and neck with CT angiography, as well as getting an MRI of the brain.”
Mount Nittany Health has a 3T MRI scanner—the most powerful MRI in Central Pennsylvania. This advanced technology is used to evaluate for small strokes and other issues.
Evaluation in the ED typically includes:
- Complete neurological exam
- Brain imaging (CT and/or MRI)
- Blood vessel imaging (CT angiography)
- Heart tests to identify possible sources of blood clots
- Blood tests for risk factors like diabetes and high cholesterol
TIA treatment and prevention
The primary goal of treatment is to prevent future stroke. In most cases, this involves medication and lifestyle changes rather than surgery.
“The vast majority of patients do not need surgical intervention and are managed completely medically,” Dr. Roy noted. “However, if an abnormal heart or blood vessel condition is identified, this may require surgery.”
Treatment typically includes medications and lifestyle choices. “Stroke risk factors (hypertension, cigarette smoking, diabetes, dyslipidemia, etc.) determine much of the treatment,” he explained. “However, many are put on antiplatelet medication for stroke prevention. Typically, a neurologist does not have to follow these patients long-term as most of the care revolves around risk factor and lifestyle changes.”
Medications
- Antiplatelet drugs (like aspirin or clopidogrel)
- Blood pressure medications
- Cholesterol-lowering statins
- Medications to control diabetes, if needed
Lifestyle changes
- Controlling blood pressure
- Managing cholesterol and blood sugar
- Following a heart-healthy diet
- Exercising regularly
- Maintaining a healthy weight
- Quitting smoking
- Limiting alcohol
What to do if you suspect a TIA
If you or someone near you experiences possible TIA symptoms, take these steps:
- Call 911 immediately: Even if symptoms disappear, emergency evaluation is essential
- Note the time: When symptoms started and how long they lasted
- Don’t drive yourself: Wait for emergency services
- Take note of medications: Be ready to share your current medications
- Follow through with care: Even after symptoms resolve
Remember, it is impossible to distinguish between a TIA and a stroke without proper medical evaluation, so all stroke-like symptoms should be treated as emergencies.
By recognizing the warning signs, seeking prompt medical care, and working with healthcare providers to address risk factors, you can significantly reduce your chances of experiencing a serious stroke.
If you’ve experienced TIA symptoms or have concerns about your stroke risk, our neurology team at Mount Nittany Health can help evaluate your risk. For stroke risk assessment or to discuss prevention strategies, schedule an appointment today.
Emergency reminder: If you or someone near you experiences any neurological symptoms, call 911 immediately. Don’t wait to see if symptoms improve – every minute counts when it comes to brain health.