TIAs are warning shots of a future stroke

TIAs are warning shots of a future stroke; one out five of those who have just suffered a temporary ischemic attack may have a full-blown episode within three months; and half of them will be observed inside of two days.

Time clearly is of the essence; a diagnosis must be made and action taken.


The same FAST acronym is used to diagnose a TIA as a stroke, even if the symptoms resolve in less than an hour.

  • F -  Facial drooping
  • A - Arm weakness
  • S - Speech difficulties
  • T - Time to call for an ambulance

TIA mimics

There are certain conditions that will mimic a TIA. It's important to be able to tell the difference. Examples would be a history of migraines and epilepsy.






Older person

Vascular risk factors

  • Sudden onset
  • Maximal symptoms at onset
  • Normal mental activity
  • Focal neurological symptoms such as paresis or difficulty speaking
  • Dizziness and nausea
  • Vision loss
  • Coordination and gait
  • Weakness of the trunk when sitting
  • Hypertension on presentation
  • Headache with pupillary constriction and drooping of an eyelid

TIA mimic

Younger; no vascular risk factors

Epilepsy, migraine or brain tumour

  • Symptoms that spread from the site of onset, possible seizure
  • Altered mental state

In a wealthy society a CT is initially ordered, followed by an MRI of the brain.

ABCD2 score for suspected TIA

The burning question is whether the TIA is likely to progress to a full-blown stroke. The ABCD2 score gives one some inkling of the future.

  • A - Age > 60
  • B - BP > 140/90
  • C - Clinical features, unilateral weakness and speech disturbance
  • D1 - Duration > 1 hour
  • D2 - Diabetes

  • ABCD2 TIA calculator[2]

ABCD2 score

0 - 3

4 - 5

6 - 7

2-day risk




90-day risk





It is obviously very significant that diabetes is the only disease mentioned in the ABCD2 score; by pushing one into the "high" rating, it doubles the risk of having a full-blown stroke.

For those concerned about the prevention of a stroke, BP and blood glucose levels are paramount; the two most difficult areas to achieve patient compliance. In particular it means cessation of smoking and weight loss. 

My personal belief is that it is the clinician's responsibility to point these out very firmly once; and then keep silent unless asked for guidance. Nagging achieves nothing; but no patient who has a major stroke should ever be able to say that no doctor ever made these matters absolutely clear.

For centuries orange and yellow foods have been used in the management of diabetes. The known active agents involved in lowering blood glucose are nicotinic acid and trigonelline.

Pumpkin for diabetes makes interesting reading for those concerned with both prevention and treatment.

"People with diabetes who take nonsteroidal anti-inflammatory drugs even on a short-term basis may have about a 50% greater risk of developing heart failure."

- European Society of Cardiology

From the horse's mouth

Food as medicine

Broad-leafed kale.

Interestingly there is strong evidence that dark-green leafy vegetables, and particularly the stalks are rich in the nitrates that lower blood pressure.

Vegetables like spinach, kale and broccoli should daily be on the menu; it is not necessary to devein young leaves.

Other researchers have proved that just by using food as medicine, without any drugs almost all those suffering from T2DM can put their disease completely into remission; obviously becoming more active is imperative too; and especially taking short walks after starchy meals.

Whale trail group

TIAs are warning shots of a future stroke

TIAs are warning shots of a future stroke often within days.

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