Credit: Illustration by Jason Schneider

Amy Hayward of Rockville was a 33-year-old new mother when she was stricken by an agonizing headache. She called her husband right away, just as the text on her computer screen began moving from side to side, and she slurred her words on the phone. 

Hayward drove herself to the hospital, and 30 minutes later, she landed in the emergency room. The diagnosis: a TIA, or transient ischemic attack, commonly referred to as a “ministroke.” TIAs occur when someone experiences strokelike symptoms, such as slurred speech or paralysis, for less than an hour (usually only for a few minutes).

“This definitely wasn’t on my radar,” recalls Hayward, now 42 and an executive assistant. After an MRI scan at the hospital showed no obvious cause for the TIA, she followed up with a visit to a vascular surgeon and was given a clean bill of health. “It was really scary. And there wasn’t an explanation for why it happened, which was the most jarring thing for me. The term ‘ministroke’ is misleading.”

Given that TIAs are a lack of blood flow to the brain, they shouldn’t be dismissed as small, but instead treated as emergencies, according to a recent statement from the American Heart Association. Malik Muhammad Adil, a vascular neurologist and the medical director of the stroke program at Bethesda’s Suburban Hospital, puts it this way: “ ‘Ministroke’ is a misnomer. Instead of saying ministroke, people should say, ‘I had a warning sign of a stroke.’ That represents more the urgency of the matter.”

TIAs affect about 240,000 people in the United States every year, estimates the American Heart Association, and are a powerful predictor of a stroke. Research shows that the risk of a stroke in the first 90 days after a TIA can be as high as 17.8%, with almost half occurring within 48 hours. That risk is especially high in the first 24 hours.

Yet a 2017 survey by the American Heart Association showed that while one-third of U.S. adults had experienced symptoms consistent with a ministroke, only 3% called 911. 


While some may have dodged a bullet, it’s important to know the main risk factors for TIAs. Some, unfortunately, cannot be controlled: genetics, family history of stroke or TIA, age (risk increases as a person gets older, particularly after 55), Type 1 diabetes and gender (men are at higher risk). Race is also a factor: Black and Latino people are at higher risk than white people.

Risk factors that can be directly managed include high blood pressure (increased risk begins with readings higher than 140/90), high cholesterol, obesity (chiefly in the abdominal area), cardiovascular disease, smoking, lack of exercise, poor nutrition, heavy alcohol use and drug abuse, according to the Mayo Clinic.

To decrease your risk, eat more fruits and vegetables for antioxidants; consume potassium and folate that protect and nourish the brain; and limit cholesterol, saturated fat and trans fat to reduce plaque buildup in the arteries, recommends the Mayo Clinic. The Cleveland Clinic also recommends three or four 40-minute sessions of moderate to intense aerobic exercise per week.


Anyone who has a TIA should get an MRI within 24 hours of experiencing the initial symptoms, according to the American Heart Association. Immediate treatment—doctors may recommend aspirin or anticoagulants, depending on the patient’s situation—can decrease or eliminate the risk of a stroke. 

Adil says he can’t stress enough the need for more awareness regarding the importance of seeking medical attention immediately after a TIA. “There needs to be a better understanding about this,” he says. “Time lost can be a brain lost.”

Warning Signs

Common symptoms associated with transient ischemic attacks:

Credit: Illustration by Jason Schneider
Credit: Illustration by Jason Schneider
  • Double vision, difficulty seeing or blindness in one or both eyes
  • Slurred speech or difficulty understanding others
  • Dizziness or loss of balance
  • Muscle weakness, numbness or paralysis, usually on one side of the body
  • Severe headache with no apparent cause

Sources: American Stroke Association, Mayo Clinic

This story appears in the May/June issue of Bethesda Magazine.