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Is It Normal to Be Tired for Months After a Ministroke?
Transient ischemic stroke is a temporary blockage of blood flow to the brain that can mimic a stroke, causing symptoms like numbness, weakness, or confusion that can last anywhere from a few minutes to 24 hours.
These ministrokes are treated as medical emergencies and are often seen as a warning sign for future strokes.
Ministrokes Can Have Lasting Effects on Energy Levels
Researchers in Denmark followed about 350 people for a year after they had a ministroke. Participants, who were 70 years old on average, completed questionnaires about their level of fatigue within the first two weeks of having a ministroke and again at 3, 6, and 12 months later.
One of the surveys delved further into different types of fatigue and asked people about overall tiredness, physical tiredness, reduced activity, reduced motivation, and mental fatigue. Scores ranged from 4 to 20, with higher scores indicating more fatigue. A score of 12 or higher indicated a person was experiencing fatigue.
Investigators found the following trends in fatigue after a ministroke:
- Within two weeks after the TIA, participants had an average fatigue score of 12.3, with 61 percent reporting fatigue.
- The majority of participants (54 percent) continued to experience fatigue through the full 12 months.
- At three months, the average score decreased slightly to 11.9; at six months to 11.4; and at twelve months to 11.1.
- Participants who reported previous anxiety or depression were twice as likely to have lasting fatigue.
Although conventional wisdom has been that a TIA is a temporary event without lasting effects, these findings add to the evidence that this might not be the case for all patients, says coauthor Birgitte Ebbesen, a PhD candidate at Aalborg University Hospital in Denmark.
While fatigue is common among stroke survivors, the fact that so many people had fatigue a year later was still surprising, says Ebbesen.
Why Ministroke May Lead to Fatigue
Adam Jasne, MD, a neurologist and associate professor of neurology at Yale Medicine in New Haven, Connecticut, who wasn’t involved with the study, says there could be several reasons why a TIA leads to lasting fatigue:
- A structural injury wasn’t or couldn’t be captured by imaging (such as MRI).
- Nonstructural changes to the brain might contribute to fatigue.
- Behavioral or stress-related changes like hypervigilance after the TIA could contribute to fatigue.
- Individuals with preexisting fatigue are more likely to have a TIA or a stroke, meaning fatigue is more likely to be found in those who have had a TIA or stroke than in the general population.
Although the findings bring attention to prevalence of fatigue after a TIA, there are significant limitations to the study, says Dr. Jasne. Because participants were selected from people who had just had a TIA, the participants’ level of fatigue before the event is a question mark.
“We do not have data on how many of those individuals had fatigue or severe fatigue before their TIA. Is the prevalence of fatigue after TIA any different than before it?” he wonders.
The way that TIA was diagnosed also complicates the findings — there may have actually been events that were considered a TIA that would be considered a small stroke in the United States, says Jasne.
People May Need More Support for Fatigue After Ministroke
Post-stroke fatigue itself is common, and it can contribute significantly to disability, but it isn’t always focused on as a consequence of stroke, says Jasne.
“Even more, fatigue is not commonly screened for after TIA. Studies like this could suggest the benefit of further screening for fatigue in patients with TIA,” he says.
Ebbesen believes that many people who’ve had a TIA could benefit from more care.
“In the current guidelines, the focus is on secondary prevention — and that is important. But I think there needs to be a focus on also ensuring return to everyday life by providing support to fatigue management,” says Ebbesen.
In the healthcare system, providers often view people who’ve experienced transient ischemic stroke as the “lucky” ones, since they didn’t have a full stroke, she says.
While that may be true, post-ministroke struggles shouldn’t be neglected, says Ebbesen. These people may need some of the same follow-up and rehabilitation usually reserved for people who’ve had a full stroke, she says.
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