Transient ischemic attacks are commonly referred to as “mini-strokes,” but this does not make them any less serious than major strokes. In fact, a recent study has found that around 30% of patients who have transient ischemic attacks go on to develop the symptoms of post-traumatic stress disorder (PTSD).

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TIAs are considered to be medical emergencies, just like major strokes. Recognizing and treating TIAs can prevent major strokes from occurring.

Transient ischemic attacks (TIAs) occur when the flow of blood to the brain is disrupted temporarily, often by blood clots or other debris. They differ from major strokes in that the flow of blood is only blocked for a relatively short time – usually no more than 5 minutes.

Despite only disrupting blood flow temporarily, TIAs serve as warning signs for future major strokes. They indicate that there is a partially blocked artery or a clot source in the heart. The Centers for Disease Control and Prevention (CDC) report that between 10-15% of people with TIA will experience a major stroke within 3 months.

“We found 1 in 3 TIA patients develop PTSD,” says study author Kathrin Utz from the University of Erlangen-Nuremberg, Germany. “PTSD, which is perhaps better known as a problem found in survivors of war zones and natural disasters, can develop when a person experiences a frightening event that poses a serious threat.”

The study, published in the American Heart Association journal, Stroke, is the first to examine whether TIA and an increased risk of future stroke can lead to patients developing psychiatric disorders.

For the study, 108 TIA patients with no previous history of stroke were asked to complete a series of questionnaires. A team of German and British researchers analyzed the data in order to evaluate the participants’ mental states.

The researchers found that about 30% of the TIA patients reported symptoms of PTSD and 14% showed signs of a significantly reduced mental quality of life. Around 6.5% of the participants also had a reduced physical quality of life.

TIA patients who showed signs of PTSD were also more likely to show signs of depression, anxiety and a lower overall quality of life than those who did not.

Their findings illustrate that experiencing a TIA – which does not normally cause permanent injury to the brain – can be just as traumatic to the individual as events such as surviving a war zone or natural disaster.

The researchers believe that the development of PTSD could be due to fears of having a major stroke and poor coping behaviors following a TIA. “While their fear is partly justified,” says Utz, “many patients may be overestimating their risk and increasing their chances of developing PTSD.”

“When experienced together, the symptoms from TIA and depression pose a significant psychological burden on the affected patient; therefore, it comes as no surprise that we also found TIA patients with PTSD have a measurably lower sense of quality of life.”

The patient’s response to the TIA has also been identified by the authors as a potential determining factor in whether PTSD develops afterward. Utz suggests that certain coping strategies such as denying the problem or blaming themselves could increase the risk of PTSD developing.

“It is not yet entirely clear why some people develop PTSD following a TIA, but others do not,” she says. “However, what we do know at this stage is that younger patients and patients who in general find it difficult to cope with stress are more likely to develop psychological problems following a TIA.”

Utz offers positive adaptive strategies and risk counseling as measures that could help reduce the likelihood of PTSD developing in these patients. The CDC have published advice for coping with a traumatic event. They suggest that the following steps could be helpful:

  • Understand that any symptoms being experienced may be normal, particularly following a traumatic event.
  • Try to stick to a usual routine.
  • Find ways to relax and participate in leisure activities.
  • Find support with friends, family or religious leaders. Share experiences and feelings with them.
  • Recognize that not everything in life can be controlled.

While around one third of people who have TIAs go on to have major strokes, and research shows that psychological stress can also increase the risk of stroke, it is important to recognize that TIAs are warnings, and that patients do have time to act to prevent major strokes from occurring.