- Transient ischemic attacks occur when there is a temporary blockage to the brain’s blood supply.
- Research about the potential long-term impact of transient ischemic attacks is ongoing.
- A recent study has found that people who experience a transient ischemic attack, or ‘ministroke,’ can experience fatigue for as long as a year afterwards.
Due to such health-related concerns, doctors and other medical experts are interested in the long-term struggles people may face after a transient ischemic attack.
A recent study published in Neurology, the medical journal of the American Academy of Neurology, examined fatigue following a transient ischemic attack. The Danish Physiotherapy Association funded this research.
Over half of the participants experienced general fatigue 1 year after their transient ischemic attack.
This research was a prospective cohort study exploring fatigue after a transient ischemic attack.
All participants had experienced a transient ischemic attack, were at least 18, and had started experiencing symptoms within the previous 30 days.
Researchers excluded certain individuals, such as those with terminal illnesses or those who were unable to fill out questionnaires. All participants received treatment for transient ischemic attack at Aalborg University Hospital’s stroke unit.
Researchers used two questionnaires to evaluate the participants’ fatigue levels. The first assessed fatigue in five different domains, and the second measured fatigue severity.
Participants answered these questionnaires via email or letter. One domain of fatigue was general fatigue, where a score of 12 points or more indicated pathologic fatigue.
The initial baseline assessment happened an average of around 20 days after participants experienced their transient ischemic attack symptoms. Researchers then followed up with participants at 3 months, 6 months, and 12 months.
Participants underwent MRI scans to see if they had acute infarction, which refers to injury or death of brain tissue resulting from the blockage in blood flow.
Researchers collected other participant data as well, such as age, the type and duration of transient ischemic attack symptoms, and previous history of anxiety or depression.
In all, 287 participants filled out the study’s baseline questionnaires, and 250 participants filled out the final questionnaire 12 months later.
Overall, there was a high likelihood of fatigue among participants. At baseline, just over 61% of participants had pathologic fatigue. At the 12-month mark, 53.8% of participants reported pathologic fatigue.
Over 60% of participants who experienced pathologic fatigue at baseline reported pathologic fatigue 12 months later. In contrast, only 22.5% of participants who did not have a score indicating pathologic fatigue at baseline reported pathologic fatigue at the 12-month mark.
The proportion of participants who experienced acute infarction was lower among those who experienced fatigue compared with those who did not experience fatigue. Among participants who had fatigue at baseline, 13.1% had acute infarction compared to 19.8% in the participant group who did not report fatigue at baseline.
Researchers further suggested that looking for acute ischemic lesions alone is not enough to predict who will experience fatigue after a transient ischemic attack. Previous anxiety or depression was twice as common in the group that reported baseline fatigue.
The results suggest a potential long-term impact following transient ischemic attacks. Christopher Yi, MD, a board-certified vascular surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, noted the following to Medical News Today:
“Very little is known about the impact of [transient ischemic attacks], as traditional approaches to [such events] are catered around stroke prevention (i.e. hypertension control, antiplatelets, anticoagulation, or surgery)… This study offers a new perspective on the lingering effects of transient ischemic attacks, which were traditionally thought to have no long-term consequences. This may add a new dimension to our approach to the management and workup of chronic fatigue.”
This study does have a few limitations. For one, it was conducted out of one stroke unit in one hospital in Denmark. This could indicate the need for more diverse research in the future and a lack of generalizability.
Then, the researchers acknowledged the possibility that relatives of the participants assisted with questionnaire responses, which could have affected their accuracy.
Furthermore, some participants were excluded because they declined participation due to a lack of energy, which would indicate they also had fatigue. Researchers suggest that this could have led to selection bias, leading to “an underestimation of fatigue prevalence.” Thus, even more research into fatigue may be warranted in the future.
Continued research should look at why people develop fatigue after transient ischemic attacks, as the current study could not determine this.
This data explores a long-term outcome of transient ischemic attacks. As research moves forward in this area, doctors may be encouraged to assess people for fatigue and offer appropriate support. It may also indicate the need for more follow-up regarding fatigue after people experience a transient ischemic attack.
Speaking to MNT, Yi noted:
“Fatigue should be proactively assessed during follow-ups after a transient ischemic attack, even in patients who seem neurologically intact. Additionally, patients should be made aware that transient ischemic attacks can have ongoing effects, which might improve expectations and support seeking timely care.”
The study authors point out that their findings indicate that fatigue levels among patients who experience a transient ischemic attack are comparable to those of stroke patients.
They also note that fatigue may make it challenging to recover after a transient ischemic attack and negatively impact a person’s attempts to make lifestyle changes. They argue that rehabilitation efforts might be as relevant for transient ischemic attack patients as they are for stroke patients.
Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in this research, told MNT that:
“By identifying the patients who develop fatigue soon after a [transient ischemic attack], we are better able to focus our efforts to support these patients to manage their symptoms and improve their quality of life. We traditionally think of transient ischemic attacks as short-lived events that have limited long-term impact on patients. Based on these findings, we should consider improved screening to identify these patients at risk for suffering longer-term consequences to their quality of life.”
