Ask an Expert: Stroke vs. TIA

“My husband, who is 65 years old, had a mild stroke three months ago. Now he is taking aspirin and Pravastatin. I need help understanding what happened to him and how to care for him. Is a TIA truly a stroke, or is it caused by other problems? If it is a stroke, shouldn’t my husband be seeing a stroke specialist, in addition to his family doctor? What is the process for finding a good specialist?”

Answer from Ted Lowenkopf, M.D., medical director of Providence Stroke Center:

First, let’s discuss the difference between stroke and TIA:

Stroke is a brain injury that happens when the blood supply to a part of the brain is interrupted. Without blood and oxygen, the brain tissue starts to die, and the functions controlled by the affected brain cells – such as speech, muscle movement and memory – become mildly to severely impaired. Most strokes are caused by a blood clot blocking an artery leading to the brain. These are called ischemic strokes. A smaller percentage of strokes are caused when a blood vessel in the brain bursts open, spilling blood into the brain and damaging the surrounding tissue. These are called hemorrhagic strokes.

TIA (transient ischemic attack, also sometimes called a “mini-stroke”) begins just like an ischemic stroke; the difference is that in a TIA, the blockage is temporary and blood flow returns on its own. Since blood flow is interrupted only for a short time, the symptoms of a TIA don’t last long – usually less than hour.

Even though TIA symptoms go away, you should never ignore a TIA; it is often a warning sign that a major stroke may happen soon. A person experiencing signs of a TIA should call 9-1-1 and get to an emergency department at once. This preventive measure could help prevent a fatal or disabling stroke.

To answer your next question, strokes and TIAs are caused by the same problems. The risk factors that lead to both strokes and TIAs most commonly include:

  • High blood pressure (hypertension)
  • High cholesterol
  • Diabetes
  • Irregular heart rhythm (specifically atrial fibrillation)
  • Carotid artery disease
  • Smoking

Since your husband has had a TIA, he is already at increased risk of a second TIA or a stroke. That makes it especially important that he be evaluated for these other risk factors, and that he work with his primary care physician to treat any conditions that could further increase his risk.

To help care for your husband, the most important things you can do are as follows:
  1. Memorize the warning signs of a stroke and know what to do immediately if your husband shows any of the signs.
  2. Share this information with everyone your husband spends time with on a regular basis.
  3. Actively support your husband’s efforts to reduce his risk factors.

If you’ve spoken with your husband’s primary care physician and you still have questions about what might have caused his TIA and what preventive actions he should be taking, then a referral to a stroke specialist may be appropriate.

To locate a stroke specialist in your area, ask your primary care physician for a recommendation, or call your local branch of the American Stroke Association or the National Stroke Association for a list of primary certified stroke centers near you. In the Portland area, Providence Stroke Center has specialists who see patients for all phases of stroke/TIA evaluation, treatment and follow-up care.