Microstroke: Symptoms and Signs in Women and Men

If speech becomes slurred for a few minutes and an arm feels as if it belongs to someone else, it may be a transient ischemic attack, commonly called a microstroke. Let us examine the mechanism, the signs in women and men, and why a resolved attack requires medical evaluation.

What a microstroke and a transient ischemic attack are

A microstroke, or transient ischemic attack (TIA), is an acute transient ischemic disturbance of cerebral circulation. One of the vessels supplying the brain is temporarily blocked — most often by a thrombus carried from another part of the body, sometimes by a piece of fatty tissue or an air bubble; the area of the brain is left without oxygen. This causes speech and vision disturbances, numbness or weakness of the face, arms and legs. No cerebral infarction forms, and the signs resolve on their own — usually within minutes or hours, entirely within 24 hours.

First signs of a microstroke

The signs arise suddenly. They are conveniently remembered by the word FAST: Face — the face is distorted to one side, the person cannot smile, the corner of the mouth or an eyelid droops; Arms — the person cannot raise both arms and hold them up because of weakness or numbness in one; Speech — speech is slurred or the person does not speak at all although conscious, and poorly understands what is said. The fourth letter, Time, reminds that every minute counts.

• numbness or weakness, especially on one side of the body;
• confusion, difficulty speaking or understanding speech;
• vision disturbance in one or both eyes;
• difficulty walking, dizziness, loss of balance and coordination.

Symptoms of a microstroke in women and in men

No separate "female" or "male" set of signs is distinguished: TIA manifests identically in women and men, and the picture depends on the affected vessel. In the vertebrobasilar territory there may be systemic vertigo with nausea, diplopia, nystagmus, occipital headache, visual field loss, drop attacks, transient global amnesia. In the carotid territory — transient paresis of half the body or of one limb, hemitype numbness extending to the fingers, speech impairment of the partial motor aphasia type.

Risk factors are listed without division by sex: age over 55 years, arterial hypertension, atherosclerosis of the carotid and vertebral arteries, smoking, obesity, high cholesterol, excess alcohol, atrial fibrillation and other heart diseases, diabetes mellitus. An increased risk has been noted in people of Asian, African and Caribbean origin.

Stroke on legs: how it can go unnoticed

"Stroke on legs" is a common name for a situation in which an attack goes unnoticed: patients often do not attach importance to temporary symptoms and do not consult a doctor. The frequency of such episodes is difficult to assess for the same reason.

Examination after a microstroke: what the doctor assesses

In the first hours it is impossible to distinguish a TIA from a completed stroke, so such symptoms are a reason for emergency evaluation in a hospital, even if everything has resolved by the time doctors arrive; a specialist examination must take place within 24 hours of the onset of the attack. The doctor assesses neurological symptoms and risk factors and, if necessary, orders brain MRI, including diffusion-weighted imaging, and an examination of the carotid arteries. Risk reduction is then discussed: lifestyle correction, medications affecting the cause of the attack, sometimes carotid endarterectomy to eliminate carotid artery blockage.

Why a microstroke is dangerous and why one must not wait

A TIA is a warning sign of the risk of a full stroke in the near future: in 30–50% of those who have had one, a stroke develops within five years. Waiting "until it passes on its own" is the worst strategy: the symptom has disappeared, but the risk remains. If an attack occurred earlier and you did not consult a doctor, you should book an appointment without delay.

Call 103 or 112 immediately if a person's face has suddenly become distorted, they cannot hold up both raised arms because of weakness in one, speech has become slurred or lost, a visual field has dropped out, diplopia has appeared, or there is sudden severe dizziness with loss of balance. A call is also needed when everything has passed a minute later: a microstroke cannot be distinguished from a stroke on the spot.

This material is for reference: it helps to recognize the signs of a transient ischemic attack but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer