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The most important steps to take after a ministroke
A ministroke is a big deal. But if you react appropriately, you could avoid a more serious emergency.
You probably know what a stroke is. It occurs when blood flow to the brain is interrupted or reduced, and brain cells die. That’s an emergency, and it can cause lasting disability. But before you think the worst, know this: Stroke is preventable and treatable, according to the Centers for Disease Control and Prevention (CDC). And your first step is knowing about ministrokes.
What is a ministroke? The medical name is “transient ischemic attack,” or TIA. Like a full-blown stroke, a TIA also happens when the brain’s blood vessels become narrowed or blocked. But because it’s “transient,” the blood flow is only briefly interrupted. It usually returns within a few minutes, before any serious damage is done. But make no mistake: A ministroke is also an emergency.
To complicate things, there’s no way to know in the beginning whether your symptoms are from a TIA or from a major type of stroke, the CDC warns. By all measures, you should view a ministroke as a critical warning sign. According to the Mayo Clinic, about 30% of people who have a TIA go on to have a full-blown stroke. And the risk is highest during the 48 hours after a ministroke.
But if you act quickly, and then make the necessary long-term changes, you may be able to prevent a major stroke or lower your chances of having one in the future, the CDC notes. (If part of your prevention plan includes medication, Optum Perks can help you afford your treatment. Learn how.)
What happens during a ministroke?
When the blood stops flowing to your brain because of an artery blockage, your brain can be deprived of oxygen and nutrients. But the effect can be different for everybody. “The symptoms of the TIA depend on the brain area that’s deprived of blood flow and what function it controls,” says Charles C. Flippen II, MD, director of neurology residency at UCLA.
In some cases, the effects are so mild that you might brush them off. In fact, the American Heart Association Stroke Council reports that about 1 in 4 people over the age of 80 have had one of these “silent” strokes without even knowing it. Possible signs of a ministroke include any or all the following:
- Weakness or numbness, especially on 1 side of the body
- Double vision
- Loss of balance
- Garbled speech
- Slurred speech
What causes the brain blockage?
Blocked or narrowed blood vessels are often caused by fatty deposits that build up in blood vessels. Or as Dr. Flippen puts it, “cholesterol-laden deposits within blood vessels that cause hardening of arteries.”
Over time, these deposits may rupture and can lead to clots that stop blood flow. But you can have a ministroke even before that. When the deposits cause blood vessels to narrow, Dr. Flippen says, “the pressure within the vessel may drop to a point that the blood cannot push past the narrow area, or what we call insufficient flow.”
While fatty deposits may be the immediate cause, the underlying problem is usually chronic disease, says Dr. Flippen. Years of high blood pressure, diabetes and high cholesterol are all responsible for plaque formation. (Read more about how to keep your blood pressure in check.)
Most important things to do immediately after a ministroke
TIAs and full-blown strokes both begin the same way. “You do not know which is occurring at the start of the symptoms,” says Dr. Flippen. Will your brain totally recover because blood flow returns before permanent damage is done? Or will brain cells be deprived of blood for too long and die? You don’t know, so you should take all symptoms seriously.
Pay attention and call 911 immediately if you have any of the signs noted above (face numbness, double vision, sudden trouble speaking, loss of feeling or strength on 1 side).
At the hospital, the attending doctor may give you a medication called a “tissue plasminogen activator,” or tPA. Often referred to as “clot busters,” tPAs can break through the blockage. They usually need to be taken within 3 hours of the onset of symptoms.
Know how to handle the next few months
After you’ve recovered from the initial scare, it’s time to start planning your future. While the first week of recovery is the most critical time, the risk of a follow-up stroke is still elevated for 3 months, says Dr. Flippen. If the underlying cause isn’t addressed, you remain at risk.
See a neurologist
After your ministroke, your primary care provider should refer you to a neurologist, says Dr. Flippen. That specialist should lead your treatment going forward. Odds are, you’ll end up taking 1 of these medications:
- Anticoagulants: Often called blood thinners, these medications reduce the chances that another clot will form. Warfarin (Coumadin®) has been around for decades, but newer anticoagulants include dabigatran (Pradaxa®), rivaroxaban (Xarelto®) and edoxaban (Savaysa®). (Click each of the drug names to access instant coupons.)
- Antiplatelets: These medications help prevent cells in your blood, called platelets, from sticking together. These include aspirin dipyridamole (Aggrenox®), clopidogrel (Plavix®) and aspirin.
- Statins: By lowering cholesterol in your blood, these medications also reduce your stroke risk. These include atorvastatin (Lipitor®), rosuvastatin (Crestor®).
Like all drugs, statins could come with side effects. Learn more about how to prevent them with our guide.
“If you’re a smoker, quit!” Dr. Flippen says. Cigarettes are associated with a high stroke risk, among many other health risks. Need help? See if your insurance covers a smoking cessation program. Most do. There are also medication options: A study in the journal Addiction found that people were 82% more likely to quit smoking while using the prescription medication varenicline (Chantix®). (Download a coupon for Chantix now.)
Eat more plants
In a study of more than 200,000 people published this year, Harvard researchers found that those who consumed the most plants (while limiting sweetened beverages and refined grains) were 10% less likely to have a stroke.
Start exercising regularly
One way to help reduce your odds of having a major stroke is to stay active. When you make a habit of exercise, you’re improving 2 risk factors at once: your heart health and your body weight. But be sure to check in with your doctor about your exercise goals. You might need to begin slowly to prepare your body for more strenuous workouts.
Teach family and friends what to do if it happens again
If you’re at high risk for stroke, make sure the people you live with or see often know what to look for, says Dr. Flippen. “Using the F.A.S.T. warning signs from the American Stroke Association is a good way to identify a stroke,” he says. This handy acronym is a checklist that your loved ones can use to spot stroke signs and know when to call 911.
- F: Face. Ask the person to smile. Is 1 side drooping?
- A: Arm. Ask them to hold out their arms. Is 1 drifting downward?
- S: Speech. Ask them to say something. Does it sound strange or not make sense?
- T: Time to call 911. If the answer to any of the above questions is yes, you need emergency assistance.
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Stroke basics: Centers for Disease Control and Prevention
Stroke vs. ministroke: Mayo clinic
1 in 4 people over age 80 have had a silent stroke: American Heart Association Stroke Council
Plant-based diet and stroke risk: Neurology. (2021.) “Quality of Plant-based Diet and Risk of Total, Ischemic, and Hemorrhagic Stroke.”
Smoking cessation: Addiction. (2019.) “Moderators of real‐world effectiveness of smoking cessation aids: a population study.”