Have you had a TIA or mini-stroke? Here's why you shouldn't underestimate the consequences

TIA . Or if you don't want the English acronym, call it a transient ischemic attack or mini-stroke. In any case, we are faced with a situation linked to a temporary lack of blood and oxygen supply in an area of ​​the brain. Therefore, by definition, it should not leave consequences that last over time: once the blood returns to irrigate the affected area, everything goes back to how it was before. Perhaps, however, this is not always the case. And not in terms of the lesion, which tends to disappear within a few hours. But for the after-effects that can persist. Even at a distance. Because those affected by this temporary ischemia can more easily experience prolonged asthenia, even for a year, and can even see the start of a cognitive deficit that then tends to worsen. Two studies, published respectively in Neurology and Jama Neurology , say so.

Prolonged asthenia

The study, which shows that mini-strokes are associated with a perception of fatigue that persists for months, without determining the possible correlation, was coordinated by Boris Modrau , of the Aalborg University Hospital in Denmark. The study involved 354 people with an average age of 70 who had had a TIA, followed for a year. The participants filled out questionnaires on their level of fatigue and tiredness after the first two weeks after the mini-stroke and again after three, six and twelve months. The questions concerned issues such as general tiredness, physical weakness, reduced activity, reduced motivation and mental fatigue. Well, 61% of the subjects involved manifested fatigue two weeks after the mini-stroke and 54% saw the problem persist even after three, six and twelve months. All of this, it must be said, without there being an influence linked to particular deficits in blood flow demonstrated by checks of cerebral circulation. Rather, it should be noted that anxiety or depression were found to double in those who reported feeling tired after the TIA: "For future studies, people diagnosed with a transient ischemic attack should be followed in the weeks and months following to assess the presence of persistent fatigue," Modrau comments in a note. "This could help us better understand who may suffer from long-term fatigue and need further treatment."

Cognitive decline lurking

A study recently published in JAMA Neurology, coordinated by Vitor A. Del Bene of the University of Alabama, has reported a possible association between TIA without permanent consequences and progressive decline in cognitive functions (even regardless of the presence of specific risk factors). The study examined information from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, involving 30,239 participants, with first TIA, first stroke and without any problems as a control group. The results of the research suggest that, despite the rapid resolution of symptoms in mini-strokes, there may be an impact associated with long-term cognitive decline. Obviously, we need to understand what happens, since we are only talking about an association, that is, whether direct damage occurs related to temporary ischemia or there is an interaction with concomitant neurodegenerative factors.

How to behave

“The two studies confirm that there is a relationship between cerebral circulatory condition and “generic” symptoms such as asthenia, depression and reduced cognitive performance – reports Massimo Del Sette , Director of Neurology at the Policlinico San Martino Irccs in Genoa. In fact, we must never forget that a TIA, even if it does not leave cerebral lesions detectable by the usual neuroradiological tests (brain CT or magnetic resonance imaging ), represents a condition that still expresses cerebral circulatory suffering”. In this sense, it must be said, a condition called “vascular depression” is known that occurs in subjects with many risk factors and precisely “micro-strokes” affecting the brain. “Furthermore, there is mild cognitive decline of vascular origin (or “ Vascular Cognitive Impairment ” in the Anglo-Saxons), always related to circulatory insufficiency – the expert points out. Therefore, it can be said that TIA could be a marker of vascular suffering of the brain that can also be expressed with symptoms such as weakness, depression or cognitive decline. All this, without forgetting that patients who have experienced an acute cerebrovascular event, even if transitory, are victims of a post-traumatic syndrome that can present repercussions on an emotional level”. Final advice: it is necessary to carefully follow those who have had a mini-stroke, not only to prevent new episodes, but also to control manifestations that can be associated with this condition.