What we need to know about mini-strokes (TIA): symptoms, causes and prevention

In recent years, awareness of strokes and brain health has increased significantly, however, many people are unaware of TIAs (YiA), often referred to as “mini-strokes”. These brief episodes occur when blood flow to the brain is temporarily blocked, causing symptoms similar to a stroke.
Unlike a full stroke, the symptoms of mini-strokes resolve within minutes to an hour without causing permanent brain damage. Despite this, AITs should not be dismissed as harmless. These serve as urgent warning signals, indicating a high risk of major stroke in the near future if not addressed. It is important to understand the causes, symptoms, diagnostic approaches and preventive measures for TIA, emphasizing why early recognition and intervention are essential. Studies show that almost 1 in 5 people who suffer a TIA will have a stroke within three months if preventive measures are not taken, with half of these occurring within just 48 hours. Understanding and acting on the signs of a TIA can mean the difference between prevention and a potentially life-changing event.
What is a transient ischemic attack (TIA)?
A TIA occurs when a blood clot or fatty deposits (plaque) blocks the blood vessels that supply the brain for a short time. This blockage reduces the oxygen and nutrients that brain cells need to function properly. During a TIA, parts of the brain do not receive enough blood, causing symptoms similar to a stroke. However, unlike a full stroke, where blood flow can remain blocked long enough to cause lasting brain damage, the blockage during a TIA is temporary. Once the blockage is removed, blood flow resumes and symptoms disappear. TIAs are sometimes called “warning strokes” because they reveal an underlying problem with blood flow in the body that could lead to a full-blown stroke if left untreated.
Recognizing TIA symptoms
The symptoms of a TIA often look the same as those of a major stroke, but they tend to last only a few minutes to an hour. Recognizing these symptoms is very important because getting medical help right away can prevent a full-blown stroke soon after. The most common symptoms of a TIA can be remembered using the acronym FAST –
• Sagging face – One side of the face may suddenly feel saggy, droopy or look uneven. If you ask the person to smile, part of the smile may not move as much.
• Arm weakness – An arm may feel weak or numb. If the person tries to raise both arms, one arm might drift down.
• Difficulty speaking – The the person may have slurred or strange-sounding speech, or may have difficulty finding words or understanding what others are saying.
• It’s time to call for help: If any of these symptoms occur, it is essential to call emergency services immediately, even if the symptoms disappear quickly.
Other symptoms of TIA may include sudden dizziness, loss of balance or coordination, sudden blurred or double vision, and severe headaches with no known cause. Even though these symptoms may disappear quickly, they are still signs that something is wrong and require urgent medical attention.
Who is at risk for TIA?
Several factors increase the risk of TIA, including –
• High blood pressure – The leading cause of both TIA and stroke, high blood pressure puts extra pressure on blood vessels, increasing the chance of blockage.
• Diabetes – High blood sugar can damage blood vessels over time, increasing the risk of TIA.
• High cholesterol – High cholesterol can build up on artery walls, forming plaques that can block blood flow to the brain.
• Heart problems such as atrial fibrillation (AFib) – An irregular heartbeat such as atrial fibrillation (heart condition that causes the upper chambers of the heart to beat irregularly and often rapidly) can cause blood clots to form in the heart, which can reach the brain and cause a TIA.
• Smoking – Smoking damages blood vessels and makes the blood clot more.
• Obesity and lack of exercise – Being overweight and lacking exercise can increase the risk of high blood pressure, diabetes and high cholesterol.
• Age and family history – TIAs are more common in people over 55 and those with a family history of stroke or TIA.
Diagnosing TIA – A few essential steps and tests
Because TIA symptoms come and go quickly, diagnosing one can be difficult. For the most part, doctors must rely on the patient’s description of symptoms, along with various tests, to confirm a TIA and assess stroke risk.
• Medical history and evaluation of symptoms – The doctor will first ask about the symptoms – when they started, how long they lasted and if they fit a typical pattern of TIA.

• Imaging tests –
o MRI (Magnetic Resonance Imaging) – An MRI scan with diffusion weighted imaging (DWI) can detect even small areas of brain damage that a regular scan might miss.
o Carotid ultrasound – This ultrasound test uses sound waves to check for blockages or narrowing in the carotid arteries, which are large arteries in the neck that supply blood to the brain.
o CT or MR angiography – These tests help create images of the brain’s blood vessels, revealing any narrowed or blocked arteries that may be causing TIA or stroke.
• Cardiac tests –
o Electrocardiogram (ECG) – This simple test records the heart’s electrical activity, revealing irregular heart rhythms such as AFib that increase the risk of stroke.
o Echocardiogram – This ultrasound of the heart helps detect any structural problems, such as clots in the heart chambers, that could increase the risk of TIA or stroke.
Prevention of stroke after a TIA
This condition provides an essential warning that gives people a chance to take preventative measures to avoid a full-blown stroke. Prevention usually involves a combination of medication, lifestyle changes and regular health monitoring.
• Medicines:
o Antiplatelet medicines – Medicines such as aspirin or clopidogrel prevent blood cells (platelets) from clumping together, reducing the risk of blood clots.
o Anticoagulants – For those with AFib or at high risk of clotting, anticoagulants such as warfarin or newer options may be prescribed to prevent clots from forming.
o Cholesterol-lowering drugs – Statins lower cholesterol and reduce plaque build-up in the arteries, keeping blood vessels clear.
o Blood pressure medications – Controlling blood pressure with medications such as ACE inhibitors or beta-blockers reduces the risk of both TIA and stroke.
• Lifestyle changes – lifestyle changes are equally important in preventing stroke after a TIA. Key recommendations include –
o Quit smoking – Quitting smoking can immediately reduce your risk of stroke because smoking damages blood vessels and causes blood to clot.
a Healthy Diet – A balanced diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats helps control blood pressure, cholesterol and blood sugar levels.
o Regular exercise – Regular physical activity, such as brisk walking, strengthens the heart and blood vessels, helping to prevent future blood clots.
o Limit alcohol consumption – Excessive alcohol consumption increases blood pressure, a major risk factor for TIA and stroke.
Limiting your intake can help keep your blood pressure in a safe range.
Many people do not realize the seriousness of a TIA and may dismiss the symptoms as fatigue, stress or other minor problems. However, knowing the signs of a TIA and acting quickly can save lives. Awareness that educates the public about TIA and its warning signs helps ensure that people seek medical help in a timely manner, reducing the risk of a major stroke. For those with risk factors, regular check-ups, monitoring and lifestyle adjustments are essential to reducing the risk of stroke.
Although TIAs, or “mini-strokes,” are temporary, they are a clear warning sign that a major stroke may be imminent. Understanding the symptoms, risk factors, and treatment options for TIA is crucial to reducing the chances of a full stroke. By seeking immediate medical attention after a TIA, following a treatment plan, and making lifestyle changes, people can protect their brain health and improve their overall quality of life.
(Dr. Aradhana ChauhanNeurologist, Sahyadri Super Specialty Hospital, Deccan Gymkhana, Pune)