Transient Ischemic Attack: TIA Symptoms, Mini-Stroke Warning Signs and What to Do

Sudden weakness on one side of the body, difficulty speaking, facial drooping or changes in vision are symptoms many people associate with a stroke. However, what happens when those symptoms disappear after a few minutes?

It may be tempting to assume that the problem has been resolved. Temporary stroke symptoms  could be caused by a transient ischemic attack, also known as TIA or a “mini-stroke.” A TIA is an important warning that a more serious stroke may occur in the future.

There is no safe way to determine at home whether sudden neurological symptoms are being caused by a TIA or a stroke. Both would require emergency medical attention. If you or someone around you develops sudden stroke symptoms, call 911 immediately, even if the symptoms begin to improve or disappear.

What Is a Transient Ischemic Attack, or TIA?

A transient ischemic attack, which is also known as a TIA or mini-stroke, occurs when blood flow to part of the brain is temporarily interrupted. Because the affected area is not receiving enough oxygen-rich blood, a person may suddenly experience symptoms that look and feel exactly like a stroke.

During a TIA:

• Symptoms begin suddenly and may include weakness, numbness, facial drooping, vision changes or difficulty speaking.
• Blood flow is restored before permanent tissue damage occurs, so the symptoms eventually disappear.
• Symptoms may last only a few minutes, although some episodes continue longer.
• A clot, narrowed artery, abnormal heart rhythm or another circulation problem may still be present after the person begins feeling normal again.
• There is no way to determine at home whether the event is a TIA or a stroke while symptoms are occurring.

The term “mini-stroke” is commonly used, but the name can make a TIA sound less serious than it is. A TIA may be a warning that a more serious stroke could happen soon. The American Heart Association reports that the risk of stroke within 90 days after a TIA may be as high as 17.8%, and nearly half of those strokes occur within the first two days.

Because the symptoms of a TIA and stroke can be identical, sudden stroke symptoms should always be treated as an emergency, even when they improve or disappear.

What Is the Difference Between a TIA and a Stroke?

A TIA and stroke can produce the same symptoms. The main difference involves what happens to the affected tissue, not necessarily how dramatic the initial symptoms appear.

A person experiencing the event won’t be able to tell which one is happening. Even if symptoms disappear, imaging and a complete medical evaluation may be necessary to determine whether tissue injury occurred. The safest response is always the same: call 911 at the first sign of a possible stroke.

What Are the Symptoms of a TIA?

TIA symptoms usually begin suddenly. What happens during a TIA is usually the same signs as during a stroke, although they eventually improve or disappear.

TIA symptoms include:

• Sudden numbness or weakness in the face, arm or leg, particularly on one side of the body
• One side of the face drooping or appearing uneven
• Sudden difficulty speaking, slurred speech or trouble finding the right words
• Sudden difficulty understanding what another person is saying
• Sudden confusion
• Sudden blurred vision, double vision or loss of vision in one or both eyes
• Sudden dizziness or loss of coordination
• Sudden difficulty walking or maintaining balance

Symptoms can vary depending on the part of the brain or circulation affected. One person may develop obvious facial drooping and arm weakness, while another may primarily experience a sudden loss of vision or difficulty walking.

Remember the BE FAST Stroke Warning Signs

The BE FAST acronym can help you recognize several common signs of a stroke or TIA:

• B - Balance: Sudden dizziness, loss of coordination or difficulty walking
• E - Eyes: Sudden vision loss, double vision or other changes in vision
• F - Face: One side of the face droops or feels numb
• A - Arm: One arm becomes weak or numb or drifts downward when raised
• S - Speech: Speech becomes slurred, unusual or difficult to understand
• T - Time: Call 911 immediately

The “time” portion remains important even if symptoms begin improving. Feeling better doesn’t mean the danger has passed, and only a medical evaluation can determine whether the event was a TIA or a stroke that caused tissue injury.

Causes of a Mini-Stroke

A TIA is usually caused by a temporary disruption of blood flow. Unlike a stroke, the blockage clears or moves before lasting tissue injury occurs, but the reason it formed or became trapped may remain. Common causes include:

• Plaque buildup in the arteries: Cholesterol, fat and other substances can collect inside the arteries and form plaque. Over time, this buildup can narrow the arteries and make it harder for blood to reach the brain.
• A traveling blood clot: A small clot or piece of plaque can break loose somewhere else in the body, move through the bloodstream and briefly block an artery leading to the brain.
• Carotid artery disease: The carotid arteries run along both sides of the neck and carry blood to the brain. When plaque narrows these arteries, it can reduce blood flow or allow a clot to travel toward the brain.
• Atrial fibrillation and other heart conditions: Atrial fibrillation, or AFib, is an irregular heart rhythm that can cause blood to collect inside the heart and form clots. Those clots may then travel to the brain. Other heart problems can also affect circulation or increase the risk of clotting.
• Damage to the brain’s smaller blood vessels: High blood pressure, diabetes and other conditions can gradually damage the tiny blood vessels inside the brain, making a TIA or stroke more likely.

The cause may not always be obvious right away, which is why testing may look at both the brain and the cardiovascular system. Finding the source can help doctors determine how to lower the risk of another TIA or a future stroke.

Who Is at Greater Risk for a TIA?

Anyone can experience a TIA, but certain medical conditions and lifestyle factors make one more likely. Important risk factors include:

• High blood pressure
• High cholesterol
• Diabetes
• Cigarette smoking
• Atrial fibrillation
• Carotid artery disease
• Peripheral artery disease
• Other forms of cardiovascular disease
• A previous TIA or stroke
• Excess weight
• Physical inactivity
• Heavy alcohol use

Risk also generally increases with age. Family history and certain personal medical conditions may affect risk even when someone otherwise feels healthy.

How Is a TIA Diagnosed?

Diagnosing a TIA can be challenging because the person’s symptoms may have disappeared by the time they reach the hospital. There may be no visible weakness, speech problems, or loss of balance during the examination.

The person’s description of the event then becomes very important. The medical team may ask:

• Which symptoms occurred?
• Did they begin suddenly or gradually?
• Was one side of the body affected?
• Was there difficulty speaking or understanding speech?
• Did vision change in one eye or both eyes?
• How long did the symptoms last?
• Has anything similar happened before?
• What medications and medical conditions does the person have?

Doctors can also use several tests to look for signs of a stroke, find the source of the interrupted blood flow and evaluate the risk of another event. These may include:

• A neurological examination: This checks strength, sensation, reflexes, speech, vision, balance, coordination and awareness.
• Brain imaging: A CT scan or MRI may be used to look for bleeding, tissue damage or another possible cause of the symptoms. An MRI may reveal small areas of injury that are not visible on an initial CT scan.
• Blood-vessel imaging: A carotid ultrasound or imaging of the head and neck can help doctors look for narrowed or blocked arteries.
• Heart and rhythm testing: An electrocardiogram can look for atrial fibrillation or another abnormal heart rhythm, while longer monitoring may be used when the rhythm problem comes and goes. An echocardiogram may also be performed to examine the heart and look for a possible source of blood clots.
• Blood tests: These may check blood sugar, cholesterol, clotting and other factors that could affect the person’s symptoms or future stroke risk.

What Happens After a TIA?

After emergency testing, the next steps depend on what doctors believe caused the event. Doctors will want to address the underlying problem and reduce the risk of a future stroke. Follow-up care may focus on:

• Controlling high blood pressure
• Lowering high cholesterol
• Managing diabetes
• Treating atrial fibrillation or another heart rhythm disorder
• Evaluating narrowed carotid arteries
• Helping the patient stop smoking
• Improving nutrition and physical activity when appropriate
• Reviewing medications and other medical conditions

Depending on the cause, a medical plan may include medication that reduces clot formation, cholesterol-lowering treatment or a procedure to improve blood flow through a significantly narrowed artery. These decisions are highly individualized because the appropriate treatment for one cause of a TIA may not be appropriate for another.

Follow-up with a neurologist can help assess the event and the person’s future stroke risk. Cardiovascular evaluation may also be important when the suspected source involves the heart, blood pressure, cholesterol or the arteries.

A TIA is frightening, but it can also provide an opportunity to identify risks that may not have been recognized previously. Following the prevention plan and attending recommended appointments are important even if the person feels completely normal again.

Stroke Symptoms Require Emergency Care

If you are currently experiencing facial drooping, weakness or numbness on one side, difficulty speaking, sudden vision changes, confusion, dizziness or loss of balance, call 911 immediately. Call even if the symptoms begin to improve or disappear.

Do not wait for an outpatient neurology or cardiology appointment. Advanced Medical Care can assist with follow-up and ongoing risk management after you have received an emergency evaluation.

When to See a Neurologist or Cardiologist in Queens or Brooklyn After a Mini-Stroke

If you have already received emergency care for a suspected TIA, continued follow-up is important even if your symptoms have completely disappeared. A neurologist or cardiologist may help determine what caused the interruption in blood flow and whether you have risk factors that could increase the likelihood of another TIA or stroke.

Follow-up may be especially important if you have:

• High blood pressure
• High cholesterol
• Diabetes
• Atrial fibrillation or another irregular heart rhythm
• Carotid artery disease
• Cardiovascular disease
• A previous TIA or stroke
• A history of smoking
• A family history of stroke or heart disease

At Advanced Medical Care, our neurologists and cardiologists help patients  throughout Queens and Brooklyn evaluate the neurological, cardiovascular and circulation concerns that may contribute to a TIA. We can review what happened, evaluate your risk factors and help determine whether additional testing or ongoing treatment may be appropriate after your emergency assessment.

For follow-up care after a suspected TIA, please call us at 347-571-9389 in Queens or 929-552-2973 in Brooklyn to schedule an appointment, or book online to get started. We are here to help you better understand what may have caused your symptoms and what steps may help lower your risk of another TIA or stroke.

Frequently Asked Questions About Transient Ischemic Attacks

How long does a mini-stroke last?

The symptoms of a mini-stroke often last only a few minutes and usually disappear within an hour, although they can sometimes continue longer. However, there is no safe amount of time to wait before seeking help because a stroke can also begin with temporary, mild or improving symptoms.

Call 911 as soon as sudden weakness, facial drooping, speech difficulty, vision changes or other stroke symptoms begin. Do not wait for improvement.

Can TIA symptoms go away on their own?

Yes, TIA symptoms are temporary because blood flow is restored before permanent tissue injury occurs. However, the clot, narrowed artery, irregular heart rhythm or other condition that caused the event may still be present. A TIA may be a warning that a more serious stroke could happen soon, so emergency evaluation is still necessary.

Should you go to the hospital if TIA symptoms disappear?

Yes, call 911 when stroke-like symptoms begin, even if they disappear before emergency help arrives. No one can determine at home whether the episode was a TIA or a stroke that caused tissue injury.

Can you have more than one TIA?

Yes. Some people experience more than one TIA, and the symptoms may be similar each time or may change depending on which part of the brain is affected.

A second episode should never be considered expected or harmless. Every new occurrence of sudden stroke symptoms requires immediate medical attention, even if the person has previously been diagnosed with a TIA.

Can doctors tell whether you had a TIA after the symptoms are gone?

Doctors may still be able to diagnose a suspected TIA after the symptoms disappear, although diagnosis can be challenging. They will ask what happened, which symptoms occurred, how suddenly they began and how long they lasted.

Brain imaging may help determine whether tissue injury occurred, while blood-vessel imaging, heart testing and blood tests may help identify what caused the interruption in blood flow.