You’re scared you had a TIA even though you’re young, but a ton of tests came back normal.

But SOMETHING happened! Here is what you should do.

“As a stroke neurologist, I frequently encounter scenarios where young patients with minimal risk factors like hypertension, diabetes, dyslipidemia or smoking experience a transient neurological symptom,” says Atif Zafar, MD, medical director of St. Michaels Hospital in Toronto, Ontario, and former director of the stroke program at University of New Mexico Hospital.

Dr. Zafar continues, “Since it is hard to come up with an answer of what that symptom was, they are often told by their emergency medicine physicians or primary care providers that they had a TIA.”

They may even be told this after an assortment of tests turned up negative (normal).

“While certainly, this could be a TIA. And there is no doubt, we are seeing more and more young people having stroke and TIAs.

“Other probable causes like complicated migraine, hyperventilation-related tingling, minor seizures should be considered as well.

“When I talk to these patients, many of them describe symptoms that were certainly transient, definitely scary, but on evaluating further, they do not sound like cerebrovascular events to me.”

Do your symptoms travel?

“What I teach medical students or residents when they are rotating with us, and what I tell my patients, is often symptoms that have features of ‘traveling,’ meaning numbness in a hand that starts moving to the other side as the day progresses, or shaking that starts in one part of the body and then travels elsewhere in minutes to hours, is less likely to be stroke or TIA.

“There are occasions where stroke can have a gradual onset or can start to travel, but those are uncommon.”

Are your symptoms negative?

“The other common feature of TIA or stroke, although there are exceptions — and that is why clinical evaluation is warranted in every case — is stroke or TIAs are associated with negative symptoms.

“Meaning, the body loses a function rather than gains it — numbness more likely than tingling, or weakness more likely than shaking or stiffness, etc.”

In other words, with a TIA you’re losing sensation rather than gaining one, and losing the ability to move rather than having extra muscle contractions.

Nevertheless, a TIA can cause tingling — but typically on one side of the body or face rather than both sides. Also, one-sided tingling doesn’t necessarily mean a TIA.

When TIA Is High on the List

Dr. Zafar explains, “In patients where a transient spell was slurred speech, one-sided numbness or weakness, inability to speak or comprehend, balance disturbance of sudden onset, or double vision, TIA is always high on the list.”

Note that all of those symptoms are “negative,” in that they represent less efficacy of a particular function.

What to Do if You’re Young, Suspect a TIA but the Tests Are Normal

“If comprehensive workup is negative, adding long-term outpatient telemetry monitoring to the management is critical in the right group of patients (obese patients or patients with sleep apnea, patients with early-onset hypertension, etc.),” explains Dr. Zafar.

For example, the patient might be fitted with a device that records heart rhythm.

A heart rhythm disorder can cause symptoms that mimic a TIA: momentary dizziness or a faint feeling. The ensuing anxiety can then cause tremoring!

“Other things to consider are hypercoagulable [blood clotting] workup, genetic evaluation and a more thorough cardiac evaluation with a TEE [transesophageal echocardiogram], so that a PFO [congenital hole in the heart] can be ruled out.”

A PFO is a risk factor for a TIA or stroke, in that the condition can cause a blood clot in the heart that, via the hole, makes its way to the brain.

A PFO should be suspected when a young adult has TIA symptoms but is at low risk (nonsmoker, normal weight and blood pressure, etc.).

“Other rare causes [of TIA symptom mimickers] include metabolic disease like Fabry’s,” a genetic enzyme deficiency.

“In almost all cases, patients need to be seen by a vascular neurologist to ensure the right testing is offered.”

If your symptoms made you wonder about a TIA, even if you’re young, then get to the ER.

Side effects from prescription drugs can also cause symptoms that can pass for a transient ischemic attack.

Dr. Zafar is author of the book, “Why Doctors Need to Be Leaders.” His interests include vascular and endovascular neurology, and the neurosciences.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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