Transient ischaemic attack (TIA) and stroke

A small minority of the people we interviewed said that they had gone on to have a stroke after their TIA or minor stroke. A few people had already had a stroke before having a TIA or several TIAs later. Getting an early diagnosis and treatment after a TIA is very important, as it reduces the risk of a further TIA or a stroke. There are two main reasons why people may experience a delay in getting treated’ either because they themselves do not realise the significance of the symptoms, or because health professionals do not act quickly enough (see ‘Delay in seeking help‘, ‘Seeking help – routes to care‘ and ‘Understanding TIA/minor stroke‘).
Both Michelle and Mike described how their TIA episode had not been picked up as quickly as it could have been. As a consequence they had not been given medication that may have prevented them from going on to have a more serious episode. In Mike’s case, a locum ‘out of hours’ doctor told him to go to see the GP the following morning, but in hindsight Mike realises now that he should have gone straight to hospital and been prescribed medication to take immediately.

Mike had a TIA one evening, and although the symptoms subsided relatively quickly, the next day…

Age at interview 63

Gender Male

Age at diagnosis 53

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Mike’ I came home one evening about six o’clock of the evening and sat on the sofa and start, started talking to my wife [creaking] having, having driven home perfectly happy and then, sorry, suddenly, suddenly I found I really couldn’t, couldn’t, couldn’t speak at all. And I found this very, a little bit unnerving. I was accused possibly of being in the pub earlier on before I came home and I said No, No, nowhere near. Didn’t touch the pub. And so Debbie, Debbie will have got, managed to get on the phone and tried to speak to the surgery with, by then of course had closed. So she then rang NHS Direct.

Right.

Mike’ Is it all right?

Yeah, yeah.

Mike’ And they suggested that we rang the local hospital…

Debbie’ No, no we didn’t

Mike’No?

Debbie.. we rang the

Mike’ Right.

Debbie.. local GP, we had to then go back to the

Mike’Oh sorry.

Debbie.. because we went to see a locum GP.

Mike’Locum GP, sorry.

Debbie’ It was an out of service it was an out of service, out of hours service which happened to be based at a local, our local hospital. That’s why.

Mike’All right, sorry, sorry.

Debbie’ But I had already gone through had he

Mike’Yeah.

Debbie.. had a, had he, did he have a headache, did he have

Mike’ Aha, pain in the arm.

Debbie..pain in the arm and all these things, pain in his chest. So, that’s why I didn’t ring an ambulance.

Mike’ And so we, we, after we discovered the, the name and place of this, this doctor we went, went off and, set off and managed to see him, I don’t know what time of day it was by then probably half past seven eight o’clock.

Debbie’ Yeah.

Mike’ We managed to get in, get in to see him. And he took my blood pressure which was 250

Debbie’ Yeah.

Mike’ over 150.

Debbie’ 140

Mike’ 140, hundred and

Debbie’ 140.

Mike’ 140. 140. By that time my speech was beginning to return and I felt perfectly all right. Perfectly all right. So I thought, Well, let’s, let’s go home and forget about it. But no, he said, No, what I want you to do is promise me that you will go and see your GP in the morning. So I said, OK, fair enough. And thought not, not a lot of it after that. We were, we, we got home and did we have supper? Maybe, might have a bit of supper.

Debbie’ You had a large whiskey.

Mike’I had a large whiskey did I? Right, large whiskey. Which may not have been the, the best medicine but and then eventually we went to bed Come, come the next morning I had had what would seem to be a stroke. My face was all skew-whiff. My mouth wasat an angle and again I don’t think, could I speak?

Debbie: No.

Mike: I couldn’t speak. Or make anything not of any sense anyway.

Debbie: No sense at all.

Mike: Could I speak at all?

Debbie: No. Well

Mike: No.

Debbie:..yes, but you were talking gobbledygook.

Mike: Talking gobbledygook. OK, fair enough. And so we, as promised this doctor the night before, we went to see our GP who knew exactly why we were there. She had a fax from him and after about two minutes of being with her, she said, Right, you’re off to the, another hospital to a TIA clinic, which we took ourselves off to and we went in there and saw the chap very quickly. And within five minutes I was having an MRI scan. A few minutes after that we saw the consultant again and he said there had been a small bleed in the brain and that I’d had a stroke.

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Michelle was only in her early 20s when she experienced several episodes that her doctor diagnosed as anxiety attacks, but five months later she had a stroke. She feels that the doctors were not expecting someone of her age to have a stroke and that they didn’t listen to her when she described her initial symptoms.

Michelles TIAs went undiagnosed and after five months she had a full blown stroke. She thinks…

Age at interview 28

Gender Female

Age at diagnosis 26

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So, five months went by where you had these sort of small, mini attacks and can you tell me what happened after that?

Yes, that was in December 2007. I woke up one morning and I was so tired I went down for a drink. I had a drink and then I went back to bed. And I woke up two, two hours later. And I felt OK, I felt fine. There was no, I didn’t feel any different but when I came downstairs my, my mum said to me, Why are you walking funny? Why are you dragging your leg And I said, I didn’t know I was. So she said, Are you OK And I said, Yeah And I started feeling a little bit confused at that point And then my mum rang for a, oh no, we went to the hospital and we went all through A&E to EMU ward and they did assessments and they still never diagnosed a stroke. It, I had to come back the following day to see a consultant. And he did a CT scan and it was only from there that they’d seen I’d had a stroke.

So how long was the problem with the leg, how long did that last?

That was an ongoing thing until I’d finished
Oh right, so
…recovery.

so all during the time when you were in the hospital that
Yeah.

you were having that problem?

So it was like possibly 48, 72 hours after, before they diagnosed a stroke.

And you were admitted, and you stayed in?

No, not overnight.

No?

No, they sent me home the first night and I had to go back the following morning to see the consultant and that’s when he gave me the CT scan.

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Yvonne delayed seeing the doctor about the symptoms she experienced and carried on working although she felt very unwell. It was six weeks later when she was referred to the TIA clinic where the CT scan showed that she had had a stroke. She feels now that if she had sought help immediately it might not have been so serious (see ‘Delay in seeking help‘, ‘Seeking help – routes to care‘ and ‘Getting a diagnosis‘).

Ros, Russell and Stella had experienced a stroke before having their TIAs.

Stella had a stroke a while ago which affected her left side

Age at interview 82

Gender Female

Age at diagnosis 81

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Let’s kick off with when you first realised something was wrong?

Stella’ I didn’t know, because usually I’m very all together and know what I’m wearing and things like that.

Deborah’ But you’d got out of bed, hadn’t you, to go to the bathroom?

Stella’ I must have done, to walk to the bathroom.

Deborah’ And then that’s when it [happened].

Stella’ That alerted my neighbours.

Deborah’ And then
Stella’ And apparently I fought them, didn’t I?

Deborah’ I don’t know. I wasn’t there, was I?

Stella’ They said it was very difficult to get me dressed.

Deborah’ Mum was found on the landing, unable to move, because her left side had been paralysed. Luckily the neighbours had a spare key and managed to get into the house, and they called the paramedics. They realised that you had had a stroke.

Stella’ And when I came to I didn’t know I was in hospital.

Deborah’ So they took Mum – the paramedics arrived, the neighbours got you dressed.

Stella’ Did they?

Deborah’ Yes.

Stella’ Yes that’s right.

Deborah’ And then they took Mum to the hospital.

Stella’ And then they called my son who lives in [city], and he got going very quickly and got down to the [hospital] quickly, and beat the [hospital], the ambulance to the [hospital]. And I was there until after Christmas.

Deborah’ And you were then in intensive care for a while.

Stella’ Was I? I didn’t know that.

Deborah’ Yes, then Mum went onto the acute stroke ward and stayed there for a month, then you went down to the next level and stayed there for a month, then Mum did have physio while she was there.

Stella’ I found it very hard going there, it was quite painful, and I can’t move my fingers now, so any piano playing is out of the question.

Deborah’ The left side was affected, and as Mum only had the sight of one eye, her good eye – which was on her left side – was also affected, so that takes out reading and writing, because of the left [side paralysis] – Mum was left-handed. So everything stopped, didn’t it?

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Since her stroke Stella now has short TIAs every now and again and which make her feel…

Age at interview 82

Gender Female

Age at diagnosis 81

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Tell me a bit about the TIAs that happen. How often do they happen? How many have you had, do you know?

Deborah’ Mum’s had quite a few. She had one two weeks ago and then she had one yesterday.

Stella’ Yes.

Deborah’ Tell Louise how you felt about yesterday’s when you—

Stella’ Well, I was just sitting there having my hair done.

Deborah’ And how did you feel when you woke up?

Stella’ I don’t feel anything, I didn’t feel anything, I didn’t see anything. Because I, I’m a great one for noticing things. I think that’s partly from teaching. When you’re facing a class of children you don’t want to miss any misbehaviour.

Deborah’ But you didn’t feel………..

Stella’ I didn’t feel anything different yesterday.

Deborah’ And when the TIA happened, you can’t remember how you felt during it?

Stella’ No, no, you told me I was babbling.

Deborah’ That was the one before. I phoned and the nurse – Mum didn’t pick up the phone and I knew something was wrong. And so eventually – I kept on calling – and eventually the nurse picked up and Mum was babbling incoherently. The nurse put the phone to Mum’s ear but I don’t think Mum could hear me – and I couldn’t understand what Mum was saying. And I think that TIA went on for a lot longer than the one that Mum had yesterday which lasted 3 minutes.

Stella’ Just a moment, yes.

Deborah’ And then how do you feel, how did you feel after the TIA yesterday?

Stella’ Yesterday, nothing. I just came to

Deborah’ And did you feel tired?

Stella’ I did feel tired, yes.

Deborah’ But you didn’t feel sick or headache?

Stella’ And the one I had the day before, the few weeks earlier, I was absolutely flaked out. I was so exhausted. I said, just said to them – they had me in the hoist – and I said, Please put me on the bed. I must go on the bed. I was exhausted.

Deborah’ There was, not so much the one yesterday, but the one two weeks ago, I think because it went on longer, Mum, the next day – because that happened at 6 o’clock in the evening – the next day Mum was very tuned in with everything. We had very positive conversations, and both my brother and I were quite shocked that Mum was so much more focused. However the day after that, Mum was very confused. Mum thought I was in England, when I was still abroad, didn’t you?

Stella’ Yes.

Deborah’ So there was a lot of confusion going on. Also Mum wasn’t sure that this was Mum’s right room, and we’ve had this before.

Stella’ Yes, I thought I was in the wrong room, and so Deborah said to me, Look at the pictures on the wall. They’re your pictures from home.

So it’s that disorientation when you just don’t know where you are, what’s going on?

Deborah’ Which is what the TIA seems to produce. But obviously only when it’s a long period of time that the TIA goes on. For the shorter ones there isn’t the confusion.

How long was that first, the first one you were describing?

Deborah: The first one, 1think it was probably a lot longer than five minutes that it went on for.

But still minutes rather than hours?

Deborah: It wasn’t for hours.

No.

Deborah: Definitely not, no. I think I would need to check with the nurse as to how long it went on, but I know yesterday’s was just three minutes.

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Ros had stopped taking the medication that she had been prescribed to lower her cholesterol, and later went on to have a TIA.

After her major stroke Ros found it difficult to tolerate the medication she was prescribed so…

Age at interview 69

Gender Female

Age at diagnosis 69

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Strangely enough after that major stroke I was in hospital five days and I got over it quickly. But with the mini stroke mentally I didn’t get over it.

When you said that you got over it quite quickly on the major, the major stroke what, what were the symptoms that you had for that one?

My speech was my hand and my arm but wasn’t I couldn’t control it. But the right part of my brain affected the left side. But I could walk and I could do everything except speak properly.

Right.

Yes.

OK.

And that
So did you feel did you feel that that, I mean I know that was labelled as a major stroke
Yes.

but, but they weren’t, you, you didn’t have any lasting symptoms from that afterwards, that stayed?

No. No.

So you fully recovered?

Yes.

Right. And did you, were you put on medication for that, after that stroke?

I was advised to take simvastatin by the consultant and because I’d had a very, a lot of side effects I didn’t take the simstatin. So maybe
No.

.. that was the cause of my mini-stroke.

Were you ever given aspirin? Or told to take aspirin?

I can’t take aspirin.

OK.

Yes, they did mention that and they gave it to me in the hospital and I was vomiting so they took it off me.

And, so then there wasn’t an alternative that they could give instead?

No. No.

Right.

I was on medication, I was on blood pressure tablets, a stomach tablet and something to help me with the, the stroke but they, the one that they wanted me to take I didn’t take.

Right.

So now of course [laughs]…

What do you feel about that now then?

Well, maybe if I’d have taken the simvastatin, maybe it wouldn’t have happened.

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Russell has had two TIAs following his stroke and thinks that as he gets older he is likely to…

Age at interview 77

Gender Male

Age at diagnosis 76

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Russell’ Since I’ve had the stroke I’ve had two episodes, haven’t I really? And I do accept that I am going to have more. And I do accept that I shall get worse and more disabled.

Do you see that as inevitable?

Russell’ Yes.

And is that because of information you’ve been given by the GP or is it just your own personal feeling?

Russell’ No. I have not been told that, I just think that that’s the only way, that’s the only way forward.

Diana’ We’ve seen it happen to members of the stroke group that we meet. Twice a month.

And how does that affect you at all, the

Russell’ No, I think I can fairly say that I accept it. And it’s up to me to just to keep going as, as long, as far, as, as I can.

So you have personal responsibility too?

Russell’ I think, yes, that’s why
.. medication as well

Russell’ Do you want to lift into town? No, I’m going to walk, I’m going to go on my bicycle. That is that, that is, I must keep going I think .

What would your messages be for other people, based on your experience? Maybe people who are at risk or those who’ve already had a TIA? What would you say to them?

Russell’ I think you’ve got to be positive. You’ve got to grasp the nettle hard and, and go forward. You can go forward, you will go forward. Do what you can.

How about you Diana? Do you have any ideas about

Diana’ About the future?

Well, no, about, you know, what you’d say to other carers and people who were, who are married to somebody like Russell?

Diana’ Well I think it’s every situation’s different and you, you just have to work round. You have to be positive, it’s no good to just think you know, oh your world has come to an end. You just have to keep positive and keep moving.

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Stella is not usually aware when has had a TIA. Her daughter explains how she looks blank for a…

Age at interview 82

Gender Female

Age at diagnosis 81

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Deborah’ Now in May, we were sitting outside talking to Mum, and Mum had sunglasses on and while we were talking, I realised Mum’s facial expressions hadn’t changed. I asked her if she was alright, and I took her sunglasses off and she was just [makes a blank face to illustrate]. When I asked her if she was alright – nothing. Mum couldn’t say anything and her expression didn’t change. So we got Mum back here and the medical staff came. And Mum came out of it. So again that was probably a minute or even two minutes at the most. And Mum just felt tired, but there wasn’t any confusion then, because it seems to me the short TIAs you can get through, but if they go on longer than five minutes, then–

Stella’ They sap your energy.

Deborah’ Yes, and the confusion might just be because Mum’s tired and whacked out from it.

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See the our section on Stroke for further information.

Relationships, friends and family

Partners, friends and other family members often provided much needed support for people during and after they had their TIA or minor stroke. A number...