It lingers for a year.
Transient ischemic attacks (TIAs), often referred to as “mini-strokes,” involve a brief interruption in the brain’s blood flow. Although the blockage is temporary, TIAs can serve as a warning sign for future strokes, prompting growing concern among medical professionals about the potential long-term challenges patients may face afterward.
A recent study published in Neurology, the journal of the American Academy of Neurology, explored one such challenge: persistent fatigue after a TIA. Funded by the Danish Physiotherapy Association, the study aimed to better understand how common fatigue is in the aftermath of a TIA.
The research revealed that over 50% of participants continued to experience fatigue one year after their initial TIA. This prospective cohort study included adults aged 18 and older who had experienced TIA symptoms within the prior 30 days. Individuals with terminal conditions or those unable to complete surveys were excluded. All participants received care for their TIA at the stroke unit of Aalborg University Hospital.
To assess fatigue, researchers used two separate questionnaires. One evaluated fatigue across five domains, while the other measured the overall severity. Participants completed these surveys either by email or traditional mail. A general fatigue score of 12 or more was classified as pathologic, indicating clinical fatigue.
Initial assessments were conducted roughly 20 days after the onset of symptoms, with follow-up evaluations at three, six, and twelve months. Participants also underwent MRI scans to detect acute infarction, which signifies brain tissue damage from restricted blood flow. Additional data gathered included participants’ ages, types and durations of TIA symptoms, and any history of anxiety or depression.
A total of 287 participants completed the baseline questionnaires, and 250 completed the one-year follow-up. The results showed that at baseline, 61.3% of individuals reported pathologic fatigue. After a year, 53.8% continued to report it. Among those initially experiencing fatigue, over 60% still had symptoms one year later. Conversely, only 22.5% of those without fatigue at the beginning reported it at the one-year mark.
Interestingly, participants who showed signs of fatigue were less likely to have experienced an acute infarction than those without fatigue—13.1% compared to 19.8%, respectively. This suggests that visible brain damage may not be the only or best predictor of post-TIA fatigue. Additionally, individuals who experienced fatigue were twice as likely to have a prior history of anxiety or depression.
These findings point to the possibility of enduring symptoms after a TIA, previously considered a brief and reversible event. Dr. Christopher Yi, a vascular surgeon not involved in the research, noted that the study sheds light on a long-overlooked aspect of TIA recovery. While the standard focus has been on stroke prevention, this study highlights the need to address lingering symptoms such as fatigue.
However, the study had limitations. It was conducted at a single hospital in Denmark, which may limit how broadly the results apply. There’s also a possibility that family members assisted participants with survey responses, potentially affecting data accuracy. Additionally, those who were too fatigued to participate may have been unintentionally excluded, leading researchers to suspect that the true prevalence of fatigue might be higher.
Further research is needed to uncover the underlying causes of fatigue following TIAs. This study did not establish a direct explanation, but it encourages clinicians to monitor for fatigue and offer appropriate support services during follow-up care.
Dr. Yi emphasized the importance of evaluating fatigue in all TIA patients, even those who appear neurologically unaffected. Making patients aware of possible lingering effects may help them manage expectations and seek early intervention.
The study authors noted that fatigue levels in TIA patients are similar to those observed in stroke survivors. This fatigue can hinder recovery and complicate efforts to adopt healthier lifestyle habits. As a result, the researchers suggest that rehabilitation programs designed for stroke patients might also benefit those recovering from TIAs.
Dr. Cheng-Han Chen, an interventional cardiologist who was also not involved in the study, added that identifying patients who develop fatigue soon after a TIA could help clinicians provide targeted care to improve quality of life. He pointed out that TIAs have traditionally been seen as brief incidents without lasting consequences—but the findings suggest a shift in perspective may be needed, along with more proactive screening and support.
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