What Is a Pre-Stroke?

A "pre-stroke" refers to a transient ischemic attack or "mini stroke." These attacks don't cause lasting damage in themselves, but may be a warning sign of a more serious stroke.

A pre-stroke is another name for a transient ischemic attack (TIA, and also called a mini stroke), which is a temporary loss of blood flow or low oxygen to an area of the brain that can cause stroke symptoms. Unlike a stroke, a pre-stroke does not damage brain cells or cause permanent damage.

Pre-strokes are warning bells, because having a pre-stroke puts people at high risk for a future stroke.

There are generally no differences between the early signs of a stroke and pre-stroke (transient ischemic attack or TIA). The difference is whether the symptoms resolve or not, but while a TIA is occurring, it is nearly impossible to know the difference. 

Both a pre-stroke and a stroke are medical emergencies. Call 911 and get to a hospital’s emergency department immediately if you have any symptoms of pre-stroke/stroke. Do not drive yourself.

The American Heart Association and the American Stroke Association suggest you know the signs of a stroke and act FAST.

F.A.S.T. is:

• Face drooping: Does one side of the face droop or is it numb? Ask the person to smile.
• Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? Weakness or numbness usually appear on one side of the body.
• Speech difficulty: Is speech slurred, is the person unable to speak, or are they difficult to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?
• Time to call 911: If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to a hospital immediately.

Other symptoms of pre-stroke and stroke include: 

• Dizziness
• Vision problems (partial vision loss in one eye, double vision, blurred vision, decreased vision)
• Headache
• Hand, face, or leg weakness or numbness

Symptoms of a pre-stroke usually last a few minutes to a few hours. Pre-stroke may occur just once, or may recur several times per day, or once a year. 

Pre-stroke (transient ischemic attack) is usually caused by a buildup of cholesterol-containing fatty deposits called plaques (atherosclerosis).

Factors that can increase a person's risk of having a pre-stroke include:

• High blood pressure (hypertension) 
• Age older than 40 years
• Smoking
• Diabetes
• Current or past history of blood clots
• Heart disease (e.g., atrial fibrillation, carotid stenosis)
• High cholesterol 
• Illegal drug use 
• Heavy alcohol use
• Recent childbirth
• Previous history of pre-stroke/transient ischemic attack (TIA)
• Sedentary lifestyle/lack of exercise
• Obesity

Pre-stroke (transient ischemic attack) is a medical emergency. When a pre-stroke is occurring, it is nearly impossible to tell if it is a full stroke. Call 911 and get to a hospital’s emergency department right away if you have any symptoms of pre-stroke/stroke. Do not drive yourself or have someone else drive. If you are having a pre-stroke/stroke, emergency medical services (EMS) can begin evaluating and treating you immediately and they are equipped to handle medical emergencies.

A pre-stroke is diagnosed with the following: 

• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Arteriography
• Electrocardiogram (ECG) of the heart
• Echocardiogram (“echo”)
• Heart monitors (also called Holter or loop monitors) 

The goal of treatment for pre-stroke (transient ischemic attack) is to reduce the risk of having a stroke in the future. 

Treatments for pre-stroke include: 

• Treating risk factors
  • Manage high blood pressure
  • Control diabetes
  • Don’t smoke
  • Treat high cholesterol and lipids
  • Statin therapy to lower cholesterol levels 
• Antiplatelet therapy
  • Helps prevent blood clots from developing
  • Options include aspirin, clopidogrel (Plavix), and the combination of aspirin plus extended-release dipyridamole (Aggrenox)
• Anticoagulant therapy
  • Also called blood thinners
  • Oral anticoagulant medications include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa, Lixiana), rivaroxaban (Xarelto), and warfarin (Jantoven) 
• Revascularization: carotid endarterectomy
  • A procedure that restores blood flow

Complications of a pre-stroke (transient ischemic attack) are a significantly increased risk of having a stroke. The risk is especially high during the first 48 hours following a pre-stroke.

One in three patients who have a pre-stroke will experience a future stroke.  Any patient with a TIA will need close medical follow up even if all symptoms resolve.