What is a mini stroke?
A transient ischaemic attack (TIA) or 'mini stroke' is caused by a temporary disruption in the blood supply to part of the brain.
The disruption in blood supply results in a lack of oxygen to the brain. This can cause symptoms similar to those of a
However, a TIA does not last as long a stroke. The effects only last for a few minutes and are usually fully resolved within 24 hours.
It is important that a person who has a TIA is checked and treated as soon as possible to minimise the risk of having a further TIA or a full stroke. With treatment, the risk of a further TIA or full stroke can be greatly reduced.
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What causes a TIA?
During a TIA, one of the small blood vessels that supply your brain with oxygen-rich blood becomes blocked.
A TIA can also occur as a result of a
In rare cases, a TIA can be caused by a small amount of bleeding in the brain, known as a
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Diagnosing a TIA
As TIAs are often over quickly, you may not have any symptoms by the time you see a healthcare professional.
You'll be asked in detail about the symptoms you experienced during the TIA. For example, how long they lasted and how they affected you. This will help rule out other conditions.
If a TIA is suspected, you should be referred within 7 days of the TIA to a specialist for tests.
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Treating a TIA
Following a TIA, you'll need treatment to help prevent another TIA or a full stroke.
Your treatment will depend on your individual circumstances, such as your age and medical history. Your healthcare team will discuss the treatment options with you, and tell you about possible benefits and risks.
You may be given medication or be asked to make changes to your lifestyle. In some cases, surgery may be needed.
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Preventing a TIA
TIAs often occur without warning. If you have a TIA, it's a sign another one may follow and further TIAs can have more serious effects or develop into a full, life-threatening stroke.
Regardless of whether or not you've had a TIA or stroke in the past, there are a number of ways you can lower your risk of having either in the future. These include:
- maintaining a healthy weight
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Mini stroke symptoms
You can identify the main symptoms of a transient ischaemic attack (TIA) by remembering the word F.A.S.T. (Face-Arms-Speech-Time).
- Face – the person's face may have fallen on one side, they may be unable to smile and their mouth or eye may drop
- Arms – the person may not be able to raise both their arms and keep them raised due to arm weakness or numbness
- Speech – the person may have slurred speech
- Time – if any of these signs or symptoms are present, call for an ambulance immediately
Everyone should be aware of the signs and symptoms of a TIA or
The signs and symptoms in the F.A.S.T. test (above) can help you identify most TIAs and strokes. However, other signs and symptoms may include:
- sudden loss of vision
- communication problems, such as difficulty talking or understanding what others are saying
- balance and coordination problems
- difficulty swallowing (
- numbness or weakness, resulting in complete
- in severe cases, loss of consciousness
Duration of TIA symptoms
As the name suggests, the symptoms of a TIA are transient (temporary) and should clear up within 24 hours of the attack. The exact duration of symptoms may vary, but they often disappear within 1 hour.
Different parts of your brain control different parts of your body, so the symptoms that you will have after a TIA will depend on the part of your brain that is affected.
Sometimes, a TIA will occur before a full stroke, which can cause serious and permanent damage. Therefore, the sooner medical attention is sought, the less likely another TIA or a stroke will occur.
Mini stroke causes
During a transient ischaemic attack (TIA), one of the small blood vessels that supply your brain with oxygen-rich blood becomes blocked.
Blood is supplied to your brain by 2 main blood vessels (carotid arteries) and 2 other blood vessels (vertebral arteries). These arteries branch off into a series of smaller blood vessels that supply blood to every part of your brain.
If a blood vessel becomes blocked, the blood flow to your brain will be disrupted. In TIAs, the disruption quickly passes and your brain's blood supply soon returns to normal. In a full
The blockage in your blood vessels is usually caused by a narrowing of the arteries, or as a result of a
This can cause your blood vessels to become thickened, hard and less elastic, making it more difficult for blood to flow through them.
A TIA can also occur when a blood clot develops in a blood vessel and blocks the blood supply to your brain.
Blood clots can be caused by a number of different factors including:
- heart conditions – such as
- blood conditions – such as leukaemia (cancer of the blood cells),
A TIA can sometimes 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
In very rare cases, a TIA can be caused by a small amount of bleeding in the brain. This is known as a
A number of factors can increase your chances of having a TIA. These risk factors can either be:
- fixed – such as age and gender
- changeable – by altering your lifestyle, you may be able to reduce your risk of having a TIA
Some of the fixed risk factors associated with TIA are outlined below.
As you get older, your arteries begin to harden and narrow, increasing your risk of having a TIA.
TIAs most commonly occur in people over 60 years of age, although they can occur at any age, including in children and young adults.
Men have a higher risk of having a TIA compared with pre-menopausal women. The risk of having a TIA or stroke increases in post-menopausal women.
It's not fully understood why the risk of having a TIA increases following
In menopausal women, oestrogen and progesterone levels fall, which may cause the blood vessels to become harder and less elastic.
As people of South Asian, African and Caribbean origin have an increased risk of developing
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.
High blood pressure
High blood pressure (hypertension) is the most significant risk factor associated with TIA. Having high blood pressure puts extra strain on your body's blood vessels, causing them to become narrowed or clogged.
Weight and diet
A diet high in
Being overweight also puts your heart under strain and weakens your blood vessels.
Smoking can double your risk of having a TIA or stroke. The harmful chemicals in cigarette smoke cause the lining in the arteries to thicken, which makes your blood more likely to clot.
Certain medical conditions, such as
Diabetes causes high levels of glucose to develop in your bloodstream, which increases your risk of developing atherosclerosis.
Diagnosing a mini stroke
Seek immediate medical assistance if you or someone you know is displaying the
Receiving medical attention as soon as possible after having a TIA will lower the risk of having a further TIA or a full
TIAs are often over very quickly, so you may not have any symptoms by the time you see your doctor or another healthcare professional.
Your healthcare professional will ask about the symptoms you experienced during the TIA. For example, they'll want to know how long the symptoms lasted and how they affected you. This information will help them rule out other conditions that may have caused your symptoms.
Even if you no longer have symptoms, the healthcare professional carrying out your assessment may still need to carry out a neurological examination. This will involve doing a series of simple tasks to check power, sensation and co-ordination skills.
If the healthcare professional who assesses you suspects you have had a TIA, they'll refer you immediately to a specialist for further testing.
It's likely you'll be referred to a neurologist (a doctor who specialises in conditions that affect the brain and spine), or a consultant who specialises in strokes. Alternatively, you may be referred to a specialist TIA clinic. These are available at some hospitals and doctor surgeries.
You should be referred to a specialist or TIA clinic within 7 days of having a TIA. If you have had more than one TIA in a 7-day period, you should be seen immediately by a specialist.
Following a TIA, you may have a number of tests to check for any underlying factors or conditions that may have caused your mini-stroke. Some of these tests are described below.
If you have had a TIA, you might need a series of
- blood pressure test – your blood pressure will be checked because
- blood clotting test – your blood clotting ability will be tested to check how ‘thin’ your blood is and how likely it is to clot
- cholesterol test – a serum cholesterol test may be used to check your cholesterol levels; if you have
- glucose test – your blood glucose level will be checked; high levels of blood glucose may indicate you have
An electrocardiogram (ECG) is a test that measures your heart's electrical activity using a number of electrodes (small, metallic discs) attached to your skin.
An ECG can detect any abnormal heart rhythms, which may be a sign of conditions such as
You may have a chest
Like a CT scan, a
Treatment for a mini stroke
After having a transient ischaemic attack (TIA), you'll need treatment to help prevent another TIA or full stroke from occurring in the future.
Without treatment, there's a 1 in 10 chance that you'll have a full
Your treatment will depend on your individual circumstances, such as your age and medical history. Your healthcare team can discuss treatment options with you, and tell you about possible benefits and risks.
To reduce the risk of further TIAs or stroke, you may be prescribed medication and be advised to make changes to your lifestyle.
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Some people may also need surgery as part of their treatment programme.
Platelets are cells that help the blood to clot (thicken). If a blood vessel is damaged, platelets stick together to form a blood clot to prevent bleeding.
Anti-platelet medicines work by reducing the ability of the platelets to stick together and form clots. If you've had a TIA, it's likely you'll need anti-platelet medication.
The most commonly prescribed anti-platelet medicines for preventing a TIA, plus two other types of medication, are described below.
Aspirin and dipyridamole
Aspirin and dipyridamole are often prescribed together because they're more effective at preventing TIAs and strokes when used in combination compared to when taken separately.
Following a TIA, you'll usually be prescribed aspirin and dipyridamole for 2 years. After this time, you may be able to stop taking dipyridamole and take a low-dose aspirin instead.
Depending on what your doctor thinks is the best treatment for you, you may need to take low-dose aspirin indefinitely. A daily low dose of aspirin is thought to reduce your risk of having a TIA by 25%. It can also reduce your risk of having a
Side effects of aspirin may include:
- stomach irritation
Side effects of dipyridamole may include:
Clopidogrel is another anti-platelet medicine. It's usually only prescribed if you have:
- severe side effects from taking aspirin
- had a further TIA, despite taking aspirin
- arterial disease
Side effects of clopidogrel may include:
- abdominal pain
Anti-coagulant medicines work by reducing the level of certain chemicals in your blood needed to help the blood to clot.
You'll usually only be prescribed an anti-coagulant medicine if the blood clot that caused your TIA originated in your heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly.
It's important that you receive the correct dose of warfarin. It must be enough to ensure your blood is ‘thinner’ (less able to clot), but it should not be so thin that it causes problems, such as internal bleeding.
Your condition will be carefully monitored while you're taking warfarin. You'll need 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're getting the right amount.
Bleeding is the most serious side effect of warfarin. Seek immediate medical attention if you notice any of the following symptoms while taking warfarin:
- passing blood in your urine or stools
- passing black faeces
- severe bruising
- blood in your vomit
- coughing up blood
- unusual headaches
- in women,
If you are unable to tolerate warfarin, you may be prescribed an oral anti-coagulant medicine, such as dabigatran.
Blood pressure medication
If you have
There are lots of different types of medicine that can help control your blood pressure. Your doctor will advise you about which one is the most suitable for you. To be effective, some people have to take a combination of 2 or 3 different blood pressure medicines.
High cholesterol is another factor that may increase your risk of having a TIA. You can lower your cholesterol by making certain lifestyle changes, such as eating a
If your cholesterol level needs to be lowered with medication, you will usually be prescribed a type of medicine known as a
In some cases, you may need surgery after having a TIA or stroke. A procedure known as a carotid endarterectomy is commonly used.
Carotid endarterectomy is a surgical procedure 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.
If you have atherosclerosis, you may need a carotid endarterectomy to help reduce your risk of having a further TIA or stroke.
However, carotid endarterectomies are not suitable for everyone with atherosclerosis. For example, if your arteries are almost completely blocked, the procedure is unlikely to work.
If your carotid arteries are only partially blocked, 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.
Carotid endarterectomy is most suitable for people who have a moderate to severe blockage in their arteries. In such cases, the procedure can reduce the risk of further TIAs and strokes by more than a half.
Preventing a mini stroke
A transient ischaemic attack (TIA) often occurs without warning. Having a TIA may be a sign that another one could follow.
Further TIAs may have more serious effects, or develop into a full, life-threatening
Whether or not you have previously had a TIA or stroke, there are steps you can take to lower your risk of having either in the future. These are outlined below.
If you're overweight, your risk of having a TIA or stroke is increased. Being overweight also increases your risk of developing
You should aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or brisk walking, every week.
Make sure you
Fruit and vegetables also contain substances called antioxidants, which reduce the risk of stroke by protecting the walls of your blood vessels from damage.
Limit the amount of salt you eat to no more than 6g a day (about 1 teaspoon). Too much salt can raise 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’ salt. Therefore, always check the nutritional information on the label before buying food products.
Limiting the amount of saturated fat in your diet will help to keep your
- meat pies
- sausages and fatty cuts of meat
- ghee (a type of butter often used in Indian cooking)
- hard cheese
- cakes and biscuits
- foods containing coconut or palm oil
If you eat a lot of fatty foods, your arteries are more likely to get clogged with fatty deposits (plaques).
Drinking too much
- 2-3 units a day for women
- 3-4 units a day for men
One unit of alcohol is equal to about half a pint of normal strength lager, cider or bitter, a pub measure (25ml) of spirits, or a 50ml pub measure of fortified wine, such as sherry or port.
If you've had a TIA, you don't need to cut out alcohol altogether. Some studies have suggested 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 increases 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.
Smoking doubles your risk of having a stroke. This is because it narrows your arteries and makes your blood more likely to clot.