Warning Signs of a Ministroke

Patients must treat ministroke symptoms seriously because they often precede a stroke.

The term “ministroke” may not sound like too serious of an issue. Ministroke symptoms typically aren’t painful, may last only a few minutes and the American Stroke Association says they don’t cause permanent damage. However, experts say it’s critically important to seek medical attention immediately if they occur.

That’s because a ministroke, also known as a transient ischemic attack (TIA), should be viewed as a loud warning. It often signals that a much bigger problem could be around the corner: a full-scale stroke. Research shows about 30% of ministroke patients eventually suffer a stroke, often within 90 days.

What is a TIA or ministroke?

A TIA or ministroke is similar to an ischemic stroke. In both situations, blood flow to the brain gets blocked, often by a clot. This also prevents oxygen and key nutrients from reaching the brain.

A full-blown stroke can quickly lead to brain damage or even death if the patient isn’t treated immediately. But in the case of a ministroke, the blood clot naturally clears on its own, and the patient’s symptoms stop.

A ministroke can serve as a wake-up call to patients who may not have realized their health was in jeopardy.

“Many patients tell me they felt fine the day before [having a TIA],” says Benjamin Emanuel, DO, a neurologist and the medical director of the USC TeleStroke and Neurological Emergency Program at Keck Medicine of USC. “But a TIA is usually the result of a longstanding medical problem, whether you got care for it or not.”

What does a ministroke feel like?

A TIA or ministroke mimics a full-blown stroke in both men and women. The warning signs include weakness or numbness that is typically isolated to one side of the body, slurred speech, dizziness and loss of vision.

Ministroke symptoms occur suddenly and generally without any warning. They may last for only a few minutes or persist for up to 24 hours.

Dr. Emanuel, who is also a clinical associate professor of neurology at the Keck School of Medicine of USC, recommends memorizing the “BE FAST” acronym to remember the signs of a stroke or ministroke:

Balance loss
Eyesight changes
Face drooping
Arm weakness
Speech difficulty
Time to call 911

“A ministroke needs to be treated urgently, and you should call 911 when the symptoms start,” he stresses.

What causes ministrokes?

Dr. Emanuel says ministrokes can point to a heart health problem. “The most common reason for a TIA is high blood pressure,” he explains. High blood pressure strains the arteries and causes them to thicken and harden, which makes clots more likely to develop.

Other predominant risk factors that increase the chances of suffering a ministroke include high cholesterol, peripheral artery disease, cardiovascular disease, diabetes and obesity. Smoking cigarettes, heavy alcohol use, unhealthy eating and limited physical activity also lead to elevated risk of ministroke.

Dr. Emanuel says men are more at risk compared to women, and everyone’s odds of experiencing a TIA increases with advanced age. “The blood vessels become more fragile as we age,” he explains.

How are ministroke symptoms detected and treated?

The Roxanna Todd Hodges Comprehensive Stroke Clinic and Transient Ischemic Attack (TIA) Program at Keck Medicine of USC is one of only a few centers in southern California offering specialized care to manage TIAs.

When patients come in after experiencing signs of a TIA or ministroke, Dr. Emanuel says the first steps include a head CT and MRI scan to evaluate what triggered the symptoms. If the medical team confirms it was a ministroke, patients can then expect a full workup, including blood pressure and cholesterol tests, an A1C test to check for diabetes and an echocardiogram to examine the heart.

“We also look at the vessels in the patient’s neck and head to see if there are signs of atherosclerosis” — meaning plaque buildup in the arteries — “and look at family history,” he explains. “Anything found in the evaluation would be treated accordingly.”

Dr. Emanuel says patients have more control than they think to prevent a ministroke or full-scale stroke. “The number one thing people can do to decrease their risk is to exercise regularly. It’s a magic bullet.”

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