At only 37, store supervisor Mr Ang Tiong Boon did not fit the typical profile of someone who would have a mini stroke or transient ischaemic attack (TIA). But he did have one.

In May 2013, Mr Ang had a terrifying TIA attack, which lasted several hours. On his tea break, a colleague noticed that the right corner of his mouth was tilted up. At first, Mr Ang did not know that anything was wrong, but soon after, he felt dizzy, and numb on the right side of his face and right arm. His first thought was that he was having a stroke, as the symptoms were similar to those his mother had when she had one.

Within two hours, he was in hospital and put on a battery of tests including an MRI. Doctors also diagnosed him with high blood pressure and diabetes, which he was unaware he had.

The TIA symptoms disappeared after four hours and he was relieved it was not a full-blown stroke. But it was a sobering wake-up call to take his health seriously. “I was scared and shocked. I am still young and the main breadwinner of my family,” said Mr Ang, who is married with a five-year-old son.

In fact, Mr Ang was unaware his health had plummeted. He was working late, carrying heavy things, sleeping about six hours a night, eating whatever he wanted, drinking about eight cans of soft drinks a day and still smoking. “I realised that things had to change. On my doctor’s advice, I have stopped taking sugary drinks, quit smoking and am watching my diet. I also try not to work so late every day and get more sleep.” In addition, he takes medicine to control his high cholesterol, diabetes and high blood pressure.

No permanent damage to the brain

Dr Rajinder Singh, Senior Consultant at the Department of Neurology, National Neuroscience Institute (NNI), a member of the SingHealth group, said that a TIA is a temporary severe reduction in blood supply to certain parts of the brain or the central nervous system. This can result in stroke symptoms but without permanent damage to the brain.

The reduction in blood supply can be caused by a narrowing of a blood vessel in the brain due to the build-up of fatty deposits called plaque. It can also be due to a blood clot in a blood vessel in the brain or a blood clot in another part of the body, such as the heart, which travels to the brain and blocks the blood supply to the brain.

The effects of a TIA are temporary, unlike a stroke, which can result in permanent damage to the brain. Most patients recover from a TIA within 10 minutes to a few hours.

Stroke risk after a TIA

Dr Singh said that although Mr Ang was relatively young, he had risk factors such as poorly controlled hypertension and diabetes mellitus which increased his risk of TIA . A minor stroke must be taken seriously as it is usually a harbinger of worse things to come. It serves as a warning sign of an impending stroke, so it should not be ignored.

Dr Singh highlighted a US study published in 2000, which looked at the short-term risk of stroke and cardiovascular events among 1,707 TIA patients seen at the emergency department. Figures showed that about 5 per cent of them developed a stroke within 48 hours, and one in four had a stroke, heart attack, recurrent TIA, or died within 90 days of the TIA .

A TIA is a wake-up call and Dr Singh noted three ways patients can reduce their risk of getting another TIA or a full-blown stroke. First, they should control risk factors such as high blood pressure, diabetes, high cholesterol, as well as stop smoking. They should also make lifestyle changes, exercise and take their medication. Second, they should take blood thinning medication if there are no complications. Third, in some cases, surgery is recommended for those with moderate to severe blockage of the carotid artery, which delivers blood to the brain.

The longer a patient stays without another TIA or a stroke and with proper control of their risk factors, the lower their risk of having another TIA or stroke. The risk of stroke is highest in the first few days after a TIA .

Symptoms of a TIA

They are the same as that of a stroke (except for being transient) and can include one or more of the following:

  • Temporary numbness or weakness on one side of the body or face
  • Difficulty talking or understanding what others are saying
  • Temporary loss of vision in one eye
  • Severe dizziness or loss of balance
  • Difficulty swallowing

Anyone with any of these symptoms should get to a hospital as soon as possible as it could mean a TIA or a full stroke.

Who is at risk?

  • The elderly
  • Those with conditions such as diabetes, high blood pressure, high cholesterol, atrial fibrillation (irregular heartbeat) and heart disease which are poorly controlled
  • Smokers
  • Males are at higher risk than females

Ref: R14