You just had a mini stroke (TIA) now what? Is there anything a person can do?

Factual Questions
1

This story about the Houston Texans coach got me to thinking.

There’s a one in three chance of a major stroke within a year after a Transient Ischemic Attack.

So you come home after a mini-stroke. You feel ok. Everything still works and you can still count to ten and recite the ABC’s.

Now what? Do you just take your blood pressure meds and pray? Do you keep working until you collapse? Make that advance reservation at the local nursing home? Buy a funeral policy?

How much can doctors do to prevent a stroke?

Whats the current studies on work stress and health say these days?

2

Well, the cite you quoted seems to answer your own question, at least somewhat. Medication or surgery.

Strokes are of two kinds: A hemorrhage (burst vessel and blood spill) or blockage (blood clot). It is critical to determine which kind of stroke happened, in order to choose the correct intervention. If it’s a blockage, then anti-coagulants are given to dissolve that, but this would be exactly the opposite of what you want in case of a hemorrhage.

IANAD, so let me go out on an extremity here and guess that similar considerations would apply to TIAs.

My question: How serious does a TIA need to be (that is, how blatant the symptoms) before it will even be recognized?

I have a notion in my head that I’ve suffered a TIA (or several) about 15+ years ago, but damn if I could get a doctor to take my complaint seriously enough to even take a look. He just summarily blew me off, saying that I was too young to have any such ailment. I think I had several over a period of a few weeks (evidenced by “the worst headaches evah!” leaving me feeling groggy for a few days up to a week or more). But it seems that if the headache goes away on its own after a few days until I’m able to drive myself to a doctor, then they will summarily dismiss it.

ETA: Would this thread be better suited for IMHO, as it discusses medical stuff, or is it squarely enough in the realm of the factual to be in GQ? (Just askin’ questions. :slight_smile: )

3

My grandmother’s doctors discovered that she had several mini strokes at home. She had never said anything or went to the hospital. Tests revealed what had happened later after she had a heart attack.

I found this article on stress.

It doesn’t say if quitting your job and sitting on the beach will automatically cut stroke risk.

4

The odds of having a full-blown stroke within a year after a “mini-stroke” or TIA (i.e. transient ischemic attacks, meaning short-lived brain ‘deficits’ due to impaired blood flow, whereas a full stroke is permanent) are somewhat less than one in three. More like one in five but, hey, what’s ten, fifteen percent? The point is that it sure can happen.

Most TIAs are from small clots. So, doctors try to prevent a big one from happening. Very often that means using meds that lower the tendency for clots such as good old aspirin, or a newer agent like clopidogrel (Plavix). These type of ‘blood thinners’ - a misnomer since the blood is not thinned by them, just less likely to clot - are used primarily when the clots are presumed to originate in blood vessels going to, and within, the brain.

On the other hand, if the clot has come from the heart, then drugs such as warfarin, and more recently a burgeoning group of drugs such as dabigatran, rivaroxaban, et al, are used. Common causes of clots arising in the heart include atrial fibrillation and those that can be formed a part of the heart muscle that’s no longer moving well due to things like a previous heart attack (myocardial infarction).

5

I should have mentioned above that the use of aspirin or clopidogrel lowers the risk of subsequent stroke after a TIA by about 20 or 25 percent. Not all that impressive, frankly.

Warfarin and those others, when used for TIAs arising from the heart, reduce the risk by about 60 percent on average (offset by an increased risk of serious bleeding).

I also neglected to say that sometimes (when there is a substantial blockage in the carotid artery or one of its main branches and that has caused the TIA), then surgery, by reaming open the affected vessel (carotid endarterectomy) is used as the primary therapy.

6

Thanks KarlGauss for the information.

7

KarlGauss, how long after-the-fact can a TIA still be diagnosed, and prophylactic treatment be useful? As I wrote, I have a notion that I had undiagnosed TIAs about 15 years ago. Is it meaningful to even be thinking about it any more, after all that time?

8

I’ve always thought the term “mini-stroke” is misleading when used to refer to a TIA. (When did that term come into use anyway? It seems fairly recent.) As KG says above, a stroke is permanent death of brain tissue due to prolonged impaired blood flow to an area of the brain. Thus “mini-stroke” is/should be used to refer to death of a small amount of brain tissue. TIA is, as the name says, temporary impairment of brain function due to temporarily impaired blood flow to an area of the brain.

It’s not just an academic distinction. True mini-strokes do happen, and the cumulative effect of the resulting small permanent losses of brain tissue and function can add up to major deficits, such as multi-infarct dementia. On the other hand, multiple TIAs, although a serious portender of risk for a real stroke, would leave no deficits.

To answer the question above, if you had one TIA-like thing 15 years ago and nothing since, I would not worry about it. However, from your brief description, it sounds more like a migraine than TIA. TIAs, as I understand, don’t cause headaches.

9

TIAs are temporary impairments only for some definitions of temporary, only for some patients, and in many cases only with a lot of work.

Don Jaime de Marichalar (ex of Infanta Elena of Spain) retains some damage on the left side of his body from the one he had more than 12 years ago. This is a guy who was in his 30s at the time; he had access to the best doctors in the world.

My grandfather had TIAs for over five years before “the big one”. He’d recover 100% function on the left side, 90% on the right, but this is a guy who despite being in his 90s was made of cast iron (a neck fracture he’d had in his 80s was healed within a week) and who, after a TIA, would kept exercising the affected body parts every minute he was awake.

The mother of one of my coworkers had one three months ago. She has barely recovered, but she only exercises when the therapist is present.

All three got the same diagnosis.

10

Or to paraphrase David St. Hubbins and Nigel Tufnel: “It’s such a fine line between temporary and…” “…Permanent.”

My understanding of TIA is similar to this and this, although they too acknowledge the term “mini-stroke” in reference to TIA.
I should explain that I am biased in my understanding by virtue of being growing-older-and-ever-crustier anatomic pathologist who was long ago tutored and admonished by older and crustier anatomic pathologists to stay as much as possible, when thinking about diseases, firmly grounded in pathophysiologic processes and anatomic substrates, or, as those old fossils put it, to what’s actually going on.

With that bias in mind, I’d say the people you describe, notwithstanding the vernacular “diagnosis” they may have been given, suffered bonafide strokes and not TIAs. Or, to be inclusive, they may have suffered TIAs, but the lasting deficits you describe were caused by bonafide strokes, i.e. “permanent” death of brain tissue, rather than “temporary” functional impairment of same. That’s not to say that someone could not have a bonafide stroke and recover. Over what I would characterize as a more than a mere “transient” period of time, other areas of the brain can to some extent adapt to and take over the prior functions of areas of the brain that died, and thus a person may regain some and maybe even all of the function that was impaired. The smaller, or more “mini”, the stroke, the more likely and quickly that can happen, all else equal.

Again, I think the distinction is not merely semantic or academic, and the examples you give make that point. While our SDMB clinical physician friends undoubtedly have more direct experience in this than I (who has none), I would think that when someone suffers lasting impairment due to a bonafide stroke it is time to consider two things: (1) Intervention to mitigate the likelihood of more strokes; and (2) physical, occupational, or some other kind of therapy to work on restoring the lost function. When someone suffers temporary impairment and subsequent recovery “shortly” thereafter due to a TIA, there’s no need for (2). There is a need for (1), not to prevent more “strokes” because one hasn’t happened yet, but to prevent one from happening in the first place. The examples you provided, it sounds to me, were people who suffered bonafide strokes and then partially recovered the lost function over time, aided by therapy. (It sounds like your intrepid grandfather acted as his own physical therapist, and that he was probably cut from the same leathery cloth as the exacting and dogged old pathologists who taught me my trade.)

The partial overlap of the symptoms and intervention, as well as the similarity in the underlying pathophysiology accounting for TIAs and strokes, probably underlies the use of the term “mini-stroke” in reference to TIAs. But, IMHO, it muddies the water more than clarifies it, and gives people a false impression of what really happens/happened to them.

11

In the hour after a stroke, you could tickle your upper lip. Seriously. It works in rats.

12

My mom had a ministroke a few years ago and the symptoms cleared up within an hour or 3. Essentially, the doctors caution you that you might have a stroke in the future and watch your blood pressure. They may even put you on blood pressure medication to lower your BP, which is what I think they did with my mom.

13

I don’t know that there’s any limit to how long after the event that a TIA can still be diagnosed.

Still, even if it was a TIA that you had 15 years ago (and I’m going to assume that means you were probably younger than 40 at the time), the proof’s in the pudding. Here you are 15 years later, absent preventative therapy, and doing well. In other words, I think it’s a safe bet to say that it either wasn’t a TIA or whatever risk factors caused it back then have since disappeared (with such disappearance pretty unusual for the types of risk factors that occur in young people , i.e. they tend to be genetic risk factors and hence are irreversible. Cocaine use would be one exception, mind you). All this gets back to your (presumed) relative youth 15 years ago. For, if, say, 30 year-old had a honest-to-goodness TIA that suggests some pretty potent risk factors at work (since TIAs and strokes are, thankfully, uncommon in the young). To then survive with no further events, despite the continuing presence of those potent factors, would be very, very unlikely (all IMHO, of course).

14

Not exactly what I wanted to hear.

I had a large stroke on October 29th. It was an ischemic stroke in my right cerebellum. I went from being perfectly normal to having to crawl on the floor to get to my phone to call 911 within minutes. I was in the hospital for a week. Working on getting better now.

The neurologist prescribed clopidogrel because I can’t take aspirin (gout). Is the prognosis any better for post-stroke than post-TIA?

I should note that the first hospital I went to misdiagnosed it as an abdominal flu or food poisoning. They never did a CT.

The second hospital I went to (a day and a half later) did do a CT. The doctor let me see the results as they appeared on the screen. After a decade in radiology, I could understand what I was seeing. I think the doctor understood my “Oh, fuck.”