UNC Health Talk

Heed the Warning of a TIA (‘Ministroke’)

Sometimes, a strange feeling is just a strange feeling. Maybe you felt a wave of nausea or a sharp pain in your back, but the sensation passed in a few minutes. You’d probably go on with your day.

But if you experience signs of stroke—face drooping, trouble lifting an arm, slurred speech—don’t relax even if you feel better. Stroke symptoms that go away on their own can indicate a transient ischemic attack, or TIA, sometimes called a “ministroke.”

Because TIA symptoms resolve (within a few minutes or up to 24 hours), many people who experience a TIA don’t seek medical attention right away.

That’s a mistake, says UNC neurologist Michael Forbes, MD. “If you have a TIA, it’s really important to get checked out immediately,” Dr. Forbes says. “You should call 911, or someone else should call 911 for you. TIAs are dangerous things.”

According to the American Stroke Association, a TIA happens before about 12 percent of all strokes, and the risk of having a full-blown stroke is highest within the first 90 days after a TIA. About 9 to 17 percent of patients who have a TIA go on to have a stroke within 90 days.

“The fact that the symptoms go away quickly and then you feel all better is a false sense of security. A TIA is a warning sign that you are at risk for having a full-blown stroke,” Dr. Forbes says.

TIA and stroke are essentially the same thing, Dr. Forbes adds; think of them as different points on the same continuum. They have the same causes and the same symptoms. The difference between the two is that after a stroke, the symptoms don’t go away on their own, and the person may suffer permanent impairments in speech, vision or mobility because the brain has been damaged.

What Causes TIA?

Both full-blown strokes and TIAs happen when blood flow is cut off to an area of the brain. When the blood supply is cut off, it causes brain cells to lose oxygen and die. Full-blown strokes are either ischemic, which is caused by blockage of a blood vessel in the brain, or hemorrhagic, when a weakened blood vessel ruptures and bleeds into the brain. Ischemic strokes are much more common.

Remember, the “I” in TIA stands for ischemic. And stroke is also called a “brain attack.” So, a TIA is a “transient brain attack”: one in which the symptoms go away within 24 hours. In a TIA, the blockage is temporary and does not cause permanent brain damage.

Recognize the Signs of Stroke

Both full-blown strokes and TIAs have the same signs. A good way to recognize these signs, Dr. Forbes says, is to use the acronym BE FAST:

Balance or coordination problems: Is there sudden dizziness, loss of balance or coordination?

Eye or vision problems: Is there sudden trouble seeing in one or both eyes?

Face drooping: Does the face look uneven when smiling?

Arm weakness: When both arms are held out to the side, is one arm weak or unable to move?

Speech problems: Is speech slurred or strange-sounding?

Time to call 911: With stroke, time lost is brain lost, Dr. Forbes says. That’s why you should call 911 immediately so treatment can begin.

People suffering a stroke may also experience: sudden numbness, sudden confusion or a sudden severe headache.

Reduce Your Risk of Stroke

There are many things you can do on your own, or with the help of your doctor, to reduce your risk of stroke:

  • Eat a healthy diet and exercise.
  • If you have high blood pressure, talk to your doctor about whether you should take medications to lower it. High blood pressure is the most common cause of stroke, including TIA.
  • Stop smoking and avoid secondhand smoke.
  • If you have diabetes, manage your blood sugar through diet, exercise and medications.
  • Have your cholesterol checked. If it is high, talk with your doctor about how to lower it with medicine, a healthy diet and regular exercise.
  • Reduce alcohol consumption. More than two drinks a day for men or more than one drink a day for women increases the risk of stroke.

Some health conditions increase risk for all types of stroke. If you have carotid artery stenosis (a narrowing of the blood vessels in your neck), your risk of stroke can be reduced by medications and procedures to keep blood flowing.

If you have atrial fibrillation (an abnormal heart rhythm), talk to your doctor about how to keep it under control, such as with blood-thinning medication.


For more information, visit the UNC Hospitals Comprehensive Stroke Center.