What tests are done for mini strokes?

Transient ischaemic attack (TIA)

A transient ischaemic attack (TIA), or mini stroke, happens when there is a temporary disruption in the blood supply to part of the brain.

The disruption in blood supply results in a lack of oxygen to the brain. This can cause sudden symptoms like those of a stroke.

However, a TIA does not last as long as a stroke. The effects only last for a few minutes or hours and fully resolve within 24 hours.

Immediate action required: Phone 999 immediately if:

• you suspect you or someone else is having a TIA or stroke

Do not drive if you suspect you have had a stroke or TIA (transient ischaemic attack).

Symptoms of a TIA

Like a stroke, the signs and symptoms of a TIA usually begin suddenly.

The main symptoms of stroke can be remembered with the word FAST.

FAST stands for:

• Face – the face might drop on one side, the person may not be able to smile or their mouth may have dropped, and their eyelid may droop
• Arms – the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm
• Speech – they might slur their speech or it might be garbled, or the person may not be able to talk at all despite appearing to be awake
• Time – it’s time to phone 999 immediately if you see any of these signs or symptoms

It’s important to be aware of the symptoms of a stroke or TIA, especially if you live with or care for somebody in a high-risk group, such as an elderly person or someone with diabetes or high blood pressure.

Symptoms in the FAST test identify most strokes and TIAs. TIAs sometimes cause different symptoms that appear suddenly (usually over a few seconds).

Other signs and symptoms may include:

• complete paralysis of one side of the body
• sudden loss or blurring of vision
• dizziness
• confusion
• difficulty understanding what others are saying
• problems with balance and co-ordination

However, there may be other causes for these symptoms.

During a TIA, it’s not possible to tell whether you’re having a TIA or a full stroke, so it’s important to phone 999 immediately. Even if the symptoms disappear, you should still have an assessment at hospital.

A TIA is a warning that you’re at risk of having a full stroke. An assessment can help doctors decide the best way to reduce the chances of this happening.

Causes of a TIA

TIAs happen when there is a temporary disruption in the blood supply to part of the brain.

In TIAs, the blockage resolves before any significant damage. A full stroke disrupts the blood flow to your brain for much longer. This leads to more severe damage to the brain and longer-term problems.

The blockage responsible for most TIAs is usually caused by a blood clot that has travelled to the blood vessels supplying the brain.

A type of irregular heartbeat called atrial fibrillation can also cause TIAs. It can create blood clots that escape from the heart and become stuck in the blood vessels that supply the brain.

There are some things that can make you more likely to have a stroke or TIA:

• poor diet
• lack of exercise
• obesity
• smoking
• an excessive alcohol intake
• high cholesterol
• high blood pressure (hypertension)
• diabetes
• atrial fibrillation

Lifestyle changes can help control some of these risk factors. You may also need to take regular medication.

Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will help reduce the risk of stroke.

If you’ve had a stroke or TIA, these measures are particularly important because you’re more likely to have another stroke in future.

There are some risk factors you can’t change like:

• age – people over 65 are most at risk of having strokes, although they can happen at any age – including in children
• family history — if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher
• ethnicity – if you’re south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups
• your medical history — if you’ve had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher

Diagnosing TIAs

You should have an assessment in hospital as soon as possible if you think you’ve had a TIA.

Initial assessment

TIAs are often over very quickly, so you may not have any symptoms by the time you see a doctor.

You should tell the person assessing you about the symptoms you experienced and how long they lasted. This will help to rule out other conditions that may have caused your symptoms.

Even if you no longer have symptoms, you might still need a neurological examination. This involves simple tasks designed to check your strength, sensation and co-ordination skills.

Referral to a specialist

If a TIA is suspected, you’ll see a specialist for further tests as soon as possible.

You’ll normally take aspirin while you’re waiting for specialist assessment. This can help to reduce your risk of having a stroke or another TIA in the meantime.

It’s likely you’ll see a doctor who specialises in strokes.

Tests

You might have some tests to rule out other causes of your symptoms and to help identify the underlying cause of your TIA.

Blood tests

You might need blood tests to determine whether you have high cholesterol, and to check if you have diabetes.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures your heart’s electrical activity using electrodes (small, sticky patches) on your skin.

An ECG can detect abnormal heart rhythms, which may be a sign of conditions like atrial fibrillation (where your heart beats irregularly).

Carotid ultrasound

A carotid ultrasound scan can show if there’s narrowing or blockages in the neck arteries leading to your brain.

A small probe (transducer) sends high-frequency sound waves into your body. When these sound waves bounce back, they create an image of the inside of your body.

Brain scans

Brain scans are not always necessary if you’ve had a TIA.

You might have a magnetic resonance imaging (MRI) scan. This scan uses a strong magnetic field and radio waves to create an image of your brain.

You might have a computerised tomography (CT) scan if an MRI scan is not suitable for you. This type of scan uses a series of X-rays to produce an image of the inside of brain.

Treating TIAs

Although the symptoms of a TIA stop on their own, you’ll need treatment to help reduce the risk of another TIA or a full stroke.

Appropriate treatment following a TIA can help to reduce your risk of having one.

Your doctor will tell you about lifestyle changes you can make to reduce your stroke risk. Your doctor will prescribe medication to treat the underlying cause of your TIA. You might need surgery as part of your treatment.

Lifestyle changes

There are lifestyle changes you can make that may help reduce your chances of having a stroke after a TIA like:

• eating a healthy diet – a low-fat, low-salt, high-fibre diet is usually recommended, with plenty of fresh fruit, vegetables and whole grains
• exercising regularly – this can help lower your cholesterol level and keep your blood pressure at a healthy level
• stopping smoking if you smoke
• cutting down on the amount of alcohol you drink

Medication

Most people who’ve had a TIA will take medication to reduce their chances of having a stroke or another TIA.

After a TIA, the aim is to reduce the risk of a stroke especially in the first few days. To do this a combination of treatments is usually recommended. Some of the treatments might include:

• antiplatelets like aspirin and clopidogrel
• anticoagulants like apixaban, edoxaban, rivaroxaban, dabigatran or warfarin
• medication to lower your blood pressure (antihypertensives)
• statins to lower your cholesterol

The antiplatelet medications need to be taken immediately. Others may only be started later and usually need to be taken long term.

Carotid endarterectomy

A carotid endarterectomy is an operation to remove part of the lining of the carotid artery and any blockage in the artery.

By unblocking the carotid arteries, a carotid endarterectomy can reduce the risk of having a stroke or another TIA.

How is stroke diagnosed?

Stroke is a medical emergency. Tests for stroke usually start when you’re in the ambulance, before you get to the hospital. This is one reason why it’s important to call 911 for a stroke, rather than have someone drive you to the hospital. The goals of the tests are to figure out whether you’ve had a stroke, what type of stroke you’ve had, and what caused the stroke. This will help your doctors plan your treatment.

Physical and neurological exam

After you call 911 and the ambulance arrives, an ambulance worker will start the stroke exam. A doctor will continue the exam at the hospital. The ambulance worker or doctor will:

• Ask you or a family memberabout your symptoms and medical history.
• Do a physical exam. This includes taking your blood pressure and checking for mental alertness, numbness or weakness, or trouble speaking, seeing, or walking.
• Do a neurological exam. This test checks how well your nervous system is working to show whether you have had a stroke. In this exam, the doctor will ask you questions, test your reflexes, and ask you to do simple actions. Each part of the exam tests a different part of your brain. This test can show how serious your stroke was and where in your brain the stroke might have happened.

Imaging tests for stroke

At the hospital, you will probably get at least one imaging test that allows your doctor to see inside your brain, see how much damage was done and where the stroke happened. Some imaging tests you may get include:

• Computed tomography (CT) scan. A CT scan uses X-rays to take pictures of the brain. A CT scan of the head is usually one of the first tests used for a stroke. A CT scan can show bleeding in the brain or damage to brain cells. The CT scan also can find other problems that can cause stroke symptoms.
• Magnetic resonance imaging (MRI). MRI uses a strong magnet and radio waves to make pictures of the brain. MRI shows brain changes caused by stroke sooner than a CT scan. MRI also can show any bleeding or blood flow problems. It can rule out other problems such as tumors that can cause symptoms similar to a stroke.
• CT or MR angiogram. An angiogram is an X-ray movie of the blood vessels and blood flow through them. A dye is injected into the veins to show a detailed picture of the blood vessels after a stroke. A CT angiogram is used with a CT scanner, and a MR angiogram is used with an MRI.
• Carotid ultrasound. Carotid ultrasound is a test that uses sound waves to create pictures of your carotid arteries, which supply blood to your brain. Often used with a CT or MR angiogram, the carotid ultrasound shows whether plaque has built up in your arteries and is blocking blood flow to your brain.
• Trans-cranial Doppler (TCD) ultrasound. Doppler ultrasound is a test that uses sound waves to measure blood flow. Also used with a CT or MR angiogram, the TCD helps your doctor find out which artery in your brain is blocked.
• Electroencephalogram (EEG). An EEG is done less often. This test records electrical activity in the brain to be sure your stroke symptoms are not caused by a seizure. Seizures can cause symptoms like movement problems and confusion. These can be mistaken for the symptoms of stroke or transient ischemic attack (TIA). During this test, you’ll have sticky electrodes placed on your head, with wires attached to a machine. The machine records the electrical signals picked up by the electrodes.
• Electrocardiogram (ECG or EKG). This test detects and records your heart’s electrical activity. It can help your doctor find out if atrial fibrillation caused the stroke. An ECG can be done during physical activity to monitor your heart when it is working hard.

Blood tests for stroke

There is no blood test that can diagnose a stroke. However, in the hospital, your doctor or nurse may do a series of blood tests to learn the cause of your stroke symptoms:

• Complete blood count (CBC). A CBC measures the overall health of your blood and helps diagnose infection, anemia, clotting problems, or other blood problems.
• Serum electrolytes. This test looks at substances in your blood that carry an electric charge, called electrolytes. An electrolyte problem can cause stroke-like symptoms such as confusion or muscle weakness. Electrolytes also show whether you are dehydrated, which can cause confusion or tiredness. This test can also show whether you have kidney problems, which can change the stroke tests and treatments your doctor does.
• Blood clotting tests. These tests measure how quickly your blood clots. It is also called a coagulation panel. If your blood clots too quickly, your stroke may have been caused by a clot (ischemic stroke). If your blood clots too slowly, your stroke may have been caused by bleeding (hemorrhagic stroke).
• Heart attack tests. Your doctor may also order tests to see whether you have had a heart attack. Some women with stroke symptoms also have heart attack symptoms. Some heart problems can lead to a stroke.
• Thyroid tests. Your doctor may measure your thyroid hormone levels with a blood test. Having hyperthyroidism raises your risk of atrial fibrillation, which can lead to stroke.
• Blood glucose. This test measures the glucose (sugar) in your blood. Low blood sugar is a common complication of diabetes treatments. Low blood sugar can cause symptoms of a stroke, even when it’s not a stroke.
• Cholesteroltests. This test examines whether high blood cholesterol might have led to your stroke.
• C-reactive protein test and blood protein test. These tests look for substances in your blood that your body releases in response to swelling or inflammation. Damage to arteries is one cause of inflammation. Your doctor might order these tests to understand your stroke risk better and to determine how to treat your stroke.

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What Are Mini-Strokes? What Should You Do if You Get One?

A mini stroke, also referred to as a transient ischemic attack (TIA), is defined as a brief stroke-like attack that, despite resolving within minutes to hours, still requires immediate medical attention to distinguish from an actual stroke. Research has found that an estimated 1 in 3 people who suffer from mini strokes go on to experience a full stroke within 48 hours. A full stroke is a condition that causes a severe disruption in blood flow to the brain, damages brain cells, and can be deadly. We can’t stress enough how important it is to seek medical attention as quickly as possibly after suffering a mini stroke because time is of the essence in warding off the full stroke that’s very likely to come afterwards.

BE FAST

Knowing how to identify and decipher the warning signs of a mini stroke can be the difference between life and death. A popular acronym that the National Stroke Association uses to help people remember what to look for and what action to take in the event of a stroke is BE FAST.

B is for Balance. Sudden loss of balance or coordination.

E is for Eyes. Sudden blurred, double, or loss of vision.

F is for Face. One side of the face is drooping.

A is for Arms. Weakness in the arm or leg on one side of the body.

S is for Speech. Slurred speech, inability to speak, or difficulty to understand.

T is for Time. If any of these signs are present, it’s time to call 911 immediately.

While BE FAST is a great mnemonic device to help detect and enhance responsiveness to a person experiencing a stroke, there are a few other symptoms in addition to these that you can be on the lookout for if you think you might be witnessing a stroke event. They include:

1. Headaches that come on quickly and are localized. Oftentimes, the area affected by the headache is directly related to where the stroke occurs. 65% of people that undergo a stroke report a stroke-related headache.

2. Fainting, also called syncope episodes, are rare but can be indicative of a stroke or TIA if certain blood vessels at the base of the brain are involved.

3. Hiccups that last longer than 48 hours, are painful, and/or accompanied by chest pain can be an often overlooked symptom of stroke or mini stroke.

Causes

An ischemic stroke happens when a clot blocks the blood supply to part of your brain. In a mini stroke, or transient ischemic attack (TIA), the blockage is brief and then resolved. Because the originals of the mini stroke and a full stroke are the same, it’s very important to seek medical attention right away.

The underlying cause of a TIA is typically a buildup of cholesterol-containing fatty deposits called plaques in an artery or one of its branches that supplies oxygen and nutrients to your brain. The plaques can hinder proper blood flow through an artery and lead to a clot.

The aftermath of a stroke can be life altering. There is usually a long rehabilitation process and oftentimes, depending on different factors like age and the severity of the stroke, the recovery time can be complex and extensive. In the weeks to months after experiencing a stroke, common lingering symptoms include the following

• Cognitive issues (memory)
• Speech difficulties
• Muscle weakness, partial paralysis
• Dysphasia (difficulty swallowing) which can lead to diet and nutrition issues
• Emotional issues (depression)
• Fatigue
• Sleep disorders

SEEK MEDICAL ATTENTION

After a mini stroke, your doctor will do extensive vital exams and blood work to determine your risk factor for a stroke. The battery of tests include blood pressure checks, blood sugar, and cholesterol levels. They will also perform tests to check the integrity of your vessels and heart. If you are quick to seek medical attention after a mini stroke, you can lower your risk of suffering a full stroke by 80% through medication and basic lifestyle changes.