You probably know what a stroke is. It happens when blood flow to the brain is interrupted or reduced, and brain cells die. That’s an emergency. It can cause lasting disability. But before you think the worst, know this: Stroke is preventable and treatable. 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.

Unfortunately, there’s no way to know at first whether your symptoms are from a TIA or from a major type of stroke. By all measures, you should view a ministroke as a critical warning sign. 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.

What does a ministroke look like?

When the blood stops flowing to your brain, your brain can miss out on oxygen and nutrients. 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. Dr. Flippen is a professor and director of the neurology residency program at UCLA.

In some cases, the effects are so small that you might brush them off. In fact, about 1 in 4 people over age 80 have had one of these silent strokes without even knowing it. Possible signs of a ministroke include:

• 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 break open. This 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.”

Fatty deposits may be the immediate cause. But the underlying problem is usually chronic disease, says Dr. Flippen. Years of high blood pressure, diabetes, and high cholesterol all play a role in plaque formation.

The most important things to do right 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 without blood for too long and die? You don’t know. For that reason, take all symptoms seriously.

Call 911 right away if you have any of the signs noted above. At the hospital, you may get a medication called a tissue plasminogen activator, or tPA. Often called “clot busters,” tPAs can break through the blockage. They need to be taken within 4 hours of the onset of symptoms.

How to handle the next few months

After you’ve recovered from the initial scare, it’s time to start planning your future. The first week of recovery is the most critical time. But the risk of a follow-up stroke is still higher for 3 months, says Dr. Flippen. If the underlying cause isn’t addressed, you stay at risk. Here’s what to do during that time.

See a neurologist

After your ministroke, your primary care provider (PCP) should refer you to a neurologist, says Dr. Flippen. They should lead your treatment going forward. Odds are, you’ll end up taking 1 of these medications:

• Anticoagulants: They’re often called blood thinners. These medications lower the chances that another clot will form.
• Antiplatelets: These medications help stop platelets, or cells in your blood, from sticking together.
• Statins: By lowering cholesterol in your blood, these medications also reduce your stroke risk.

Stop smoking

“If you’re a smoker, quit!” Dr. Flippen says. Cigarettes are linked with a high stroke risk, among many other health risks. Need help? Your health plan may cover a smoking cessation program. To find out, reach out to your care advocate through the Wellframe app. This digital health management tool comes with your health plan.

There are also medication options: One study found that people were 82% more likely to quit smoking while using the prescription drug varenicline (Chantix®).

Eat more plants

In a large study from the Harvard T.H. Chan School of Public Health, researchers found that those who ate the most plants (while limiting sweetened beverages and refined grains) were up to 10% less likely to have a stroke.

Start exercising regularly  

When you make a habit of exercise, you’re improving 2 risk factors of stroke 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. Then you can work up to harder 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. “Using the F.A.S.T. warning signs from the American Stroke Association is a good way to identify a stroke,” says Dr. Flippen. This handy acronym is a checklist. Your loved ones can use it 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.

[Sources:]

[1] "Stroke." Centers for Disease Control and Prevention, June 14, 2022, https://www.cdc.gov/stroke/index.htm. Accessed August 9, 2022.

[2] “Ministroke vs. Regular Stroke: What’s the Difference?” Mayo Clinic, May 26, 2021, https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/expert-answers/mini-stroke/faq-20058390. Accessed August 9, 2022.

[3] Smith EE, Saposnik G, Biessels GJ, et al. “Prevention of Stroke in Patients with Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association.” Stroke. December 15, 2016, vol. 48, pp: e44-e71. https://www.ahajournals.org/doi/10.1161/STR.0000000000000116

[4] Jackson SE, Kotz D, West R, et al. “Moderators of Real-World Effectiveness of Smoking Cessation Aids: A Population Study.” Addiction. May 22, 2019, vol. 114, no. 9, pp: 1627-1638. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14656

[5] Baden MY, Shan Z, Wang F, et al. “Quality of Plant-based Diet and Risk of Total, Ischemic, and Hemorrhagic Stroke.” Neurology. March 10, 2021, vol. 96, no. 15, pp: e1940-e1953. https://n.neurology.org/content/96/15/e1940