Often-overlooked signs of mini-stroke, or TIA

Every year, nearly 800,000 people will have a stroke, according to the Centers for Disease Control and Prevention. Most of these strokes will be what’s called ischemic, which is when blood flow to the brain is blocked.

People who have these strokes might have already experienced what’s known as a transient ischemic attack, or mini-stroke.

“Mini-strokes are brief episodes, which are a result of lack of blood supply to a specific part of the brain,” says Dr. Ahmed Itrat, of the Cleveland Clinic’s Neurological Institute.

Itrat says that people who experience mini-strokes, or TIA, are at a higher risk of having a major stroke within the next year. When treating strokes, time is of the essence.

“Acting quickly when one is experiencing symptoms of stroke by calling emergency services and reaching the hospital in time can lead to a major impact on increased survival and reduced disability,” Itrat says.

The symptoms of a mini- and major stroke aren’t much different, but Itrat says that episodes of TIA will resolve in a short time frame. In either case, calling for help is critical.

But Itrat notes that it’s easy to brush off the signs of a mini-stroke, especially one.

No. 1 sign people miss

The top sign that you’re having a mini-stroke is often sudden-onset dizziness or trouble walking. “(These signs) may be a hallmark of an evolving stroke,” Itrat says.

He adds that these signs usually involve a subjective feeling that you or the area around you is spinning. “This may also be accompanied by nausea, vomiting and difficulty (walking),” he says.

It sounds miserable, so why might people ignore it? “Dizziness is a common symptom that can have many causes other than stroke,” Itrat says. “People often attribute dizziness to a vertigo spell related to inner ear dysfunction and do not act right away. Sudden-onset dizziness, especially in someone with risk factors for stroke, should be taken seriously and evaluated right away.”

There’s a reason you feel dizzy when having a mini- or major stroke, and it has to do with what’s going on in your body. “Acute dizziness or imbalance, called ‘ataxia,’ in a stroke or TIA occurs due to loss of blood flow to the base of the brain, which contains structures vital to the balance and coordination of the body,” Itrat explains.

This coordination includes connections from the inner ear and the cerebellum, which controls our balance.

“If untreated, this can result in injury to parts of the nearby brain critical for vital functions of the body, such as breathing and maintenance of consciousness,” Itrat says.

To be clear, dizziness isn’t a surefire sign of a mini-stroke. According to 2018 research published in the journal Stroke, dizziness is the reason for 4.4 million emergency room visits annually, and stroke is the reason for 3 percent to 5 percent of these cases.

Still, getting help as soon as possible is essential to determine the reason for the sudden spinning sensation.

Other warning signs

Itrat says that sudden dizziness is one sign of a mini-stroke, but it’s not the only one to note. Others include a sudden onset of one-sided weakness, speech difficulty and double vision or loss of vision in one eye.

Again, these symptoms are also red flags of a major stroke. They can also be signs of other disorders or issues, such as migraines.

However, Itrat says there’s a key characteristic that providers will home in on if they suspect it is a stroke.

“Symptoms of TIA or stroke usually impact one side of the body, which distinguish it from other disorders such as migraines or neuropathy, where individuals may have more generalized symptoms such as tingling on both sides of the body,” he explains.

If you suspect a mini-stroke

Just because symptoms often resolve quickly doesn’t mean a mini-stroke isn’t serious. You should seek help.

“Since there is no guarantee that the symptoms will completely resolve, it is best to seek immediate medical care by calling EMS to be taken to the nearest emergency department,” Itrat says. “If symptoms are all resolved and there is access to an urgent TIA clinic, then a detailed evaluation there can also be helpful.”

Doctors can also discuss other risk factors for a major stroke event and help you determine the next steps to protect your health long-term.

Can you recover?

“A mini-stroke or TIA refers to an episode which is self-limiting/self-resolving, and therefore, individuals should not be expected to have a disability as a result,” Itrat says.

The timetable for episodes to resolve varies.

“These episodes last from a few minutes to a few hours,” Itrat explains. “Somebody experiencing symptoms of stroke for longer than 24 hours should not be considered as having a mini-stroke/TIA.”

Mini-stroke risk factors

The risk factors for mini-strokes are similar to those for major ones. Some are modifiable. According to Itrat, they include elevated blood pressure, tobacco use, obesity, high cholesterol, abnormal heart rhythm, obstructive sleep apnea, alcohol consumption and diabetes mellitus.

“Presence of pre-existing heart disease, clotting disorder and a family history of cardiovascular disorders also predispose to stroke risk,” Itrat says. “We are seeing an alarming trend in rising rates of strokes in younger individuals, and early screening for preventable risk factors is key.”

Discuss concerns and risk factors with your primary care physician, who can take blood work and refer you to specialists as needed.