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TIA and Minor Stroke

Seeking help after a transient ischaemic attack (TIA) - routes to care

A TIA is a sign that part of the brain is not getting enough blood and that there is a risk of a more serious stroke in the future. There is no way of knowing whether a stroke or a TIA is occurring during the first few hours, so a TIA should be treated as an emergency and medical help should be sought immediately. If in any doubt the best advice is to call 999.
 
People we talked to had sought help at different stages and through a range of different routes, including a routine or urgent GP appointment, calling an ambulance, calling NHS Direct or going straight to the Accident and Emergency Department. Some said it was difficult to know when or whether to seek medical help. It could sometimes be difficult to convince the GP’s receptionist that a ‘same day’ or ‘emergency’ appointment was needed. Often this was because people did not recognise their symptoms as being serious (see Symptoms’ and ‘Delay in seeking help’) and so help was not sought immediately, particularly where the episode only lasted a short time.
 

Angus’ wife was going to call for an ambulance but the symptoms soon disappeared so he decided to...

Angus’ wife was going to call for an ambulance but the symptoms soon disappeared so he decided to...

Age at interview: 61
Sex: Male
Age at diagnosis: 60
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I was actually sat in the room where we are now, talking to my wife about Christmas dinner, and I just couldn’t talk any more. Just as quick as we are talking now it just, my voice, my speech went. I immediately knew what it was and wrote on a piece of paper, “stroke,” to my wife and she was in the process of going to ring for an ambulance and go through the process of 999 etc, when my speech come back, as quick as that, and come back, well, as it is now. And of course, it come back, I didn’t really do nothing about it straight away because I thought, “Oh, it couldn’t have been that, it’s something else, and I’ll just get in touch with my GP and make an appointment.” Which we did, and I had an appointment for the next day. I went to see my GP and he confirmed that I had a TIA.

 

 

Phillip’s symptoms only lasted a short while and seemed trivial to him, but when he told his wife...

Phillip’s symptoms only lasted a short while and seemed trivial to him, but when he told his wife...

Age at interview: 72
Sex: Male
Age at diagnosis: 71
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It was a bit worrying, but in three or four hours it had essentially completely gone. I cycled into town, that was working okay. I had my coffee. And by the evening there was a sort of residual symptom, a little bit of, still a little bit of inaccuracy in my hand placement, and a slight sense of difference in my fingers. And [name], my wife came home from work and, you know, she’d seen this in the morning and I explained I still had a little bit. And she sort of worried and said, “Look, you need to go and see your GP.
 
So the next morning I went to see my GP and I explained what this was. And it’s a tribute to the National Health Service that you can actually do this. I mean I can call them up in the morning and say, “Look, I think I’ve had this episode.” And they say, “Come right in.”
 
Because you do lie on your arm, and when you wake up it is dead. And do I want to waste my poor doctor who’s so incredibly busy time by endlessly turning up and saying, “I woke up this morning and my hand was numb. I can’t see too well”? But of course one can’t see too well for hundreds of reasons. I don’t know the answer here. That’s why I spent the whole day, and by the time it was 11 or 12 the symptoms had virtually vanished and I thought, “Well, okay, whatever it is, it’s gone away.” It was my wife who said, “No, Phillip, you really need to go and see the doctor.” She’s much more prone to go and see doctors than I am, you see, so - and absolutely wonderful, magic decision.

 

Phillip (above) rang the surgery the next morning and was quite surprised that it was treated as very urgent and he was referred to hospital that same day. Even where the symptoms did not seem to go away quite so quickly, it could still be easy to misinterpret what was happening.
Yvonne was on her way to work when she began to experience a range of symptoms and felt very unwell. She thought it was probably a reaction to some medication she’d been prescribed, or the beginning of a migraine, so she carried on with her day and did not seek medical advice or help immediately, despite the fact that colleagues told her she looked really unwell. Yvonne left it till she had a routine appointment to see the GP the following Monday. Like Phillip, she was surprised at how urgently her GP reacted when she was referred immediately to a TIA clinic but even then was still not aware of the urgency because she did not know what TIA stood for (see ‘Understanding TIA/minor stroke’ and ‘Delay in seeking help).
 

Yvonne almost collapsed when she arrived at work, but carried on working for the rest of the day....

Yvonne almost collapsed when she arrived at work, but carried on working for the rest of the day....

Age at interview: 54
Sex: Female
Age at diagnosis: 54
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I was driving to work, and I noticed that my vision had gone funny. It was getting very fuzzy around the edges. But… I have suffered from migraines in the past so I just thought maybe that was what was starting. Then my left leg went numb. My left arm went numb. Fortunately I was driving an automatic so it didn’t really matter, I didn’t have any gears to change or anything. I was starting to get a bit worried by that stage and then I felt as if my mouth had dropped. I managed to get into the police station car park. Sort of abandoned the car really, it wasn’t really parked. Kind of fell out of it thinking, “What the hell’s wrong with me?” You know, I’m just, I blamed it on the medication, because the doctor had just changed my blood pressure medication and I thought, “Oh I’m obviously reacting badly to it.” I managed to get to the back door of the police station and there’s quite a high step and I couldn’t get over it. And I remember thinking how stupid I was and how stupid I must look. And the typical thing of looking round and thinking, “Is there anybody watching me?” Eventually a colleague came a long and opened the door for me. I went through the back door and I thought, “I don’t think I can manage the stairs.” And actually stood against the wall thinking, “Well, if I’m standing against the wall if I collapse then I will just slump down the wall rather than, than pitch forward.”
 
Eventually thought, “I’ve got to get upstairs, I need to get to my office. I need to sit down.” I went upstairs in the lift. Got to the floor, went through the doors. Walked through the report writing room. And all my colleagues turned round and said, “You look awful. Why are you here?” And I said, “Oh, I’ll be fine. Don’t worry, I’m OK. Don’t worry about me. “ And I went into my office and actually worked for the rest of the day feeling awful. Having to go back over things, I couldn’t remember things. People were asking me to do things and I was thinking, “What did that person just ask me to do?” And I felt dreadful, because it’s just not me.
 
So, I came home and I said to my husband, “You know, I felt really strange today.” And told him what had happened. And he said, “Are you sure you’re OK?” And I said, “Yeah, I think so, I think it must be the medication.”
 
Felt awful the next day. But again went to work. Came back. And I was sitting here in the evening and all of a sudden I got the sensation of pins and needles in my left arm and my left leg. Passed over in a couple of minutes so I thought, “Oh, it’s definitely the medication and I’m now getting used to it.”
 
Had a doctor’s appointment on the Monday so I thought I won’t bother the doctor, I’ll just mention it, you know, when I go in on Monday.
 
Mentioned it to her eventually [laughs] and she said, “Ohh, I think I need to refer you to the TIA clinic.” I said, “Yeah, OK fine.” Not knowing what TIA clinic meant and kind of not asking really. And I came home. It was about half past seven in the evening as it was a late appointment. Came home. Phone rings at nine o’clock the next morning to say, “Can you come in tomorrow?” I got, “Sorry? What’s, you know, what’s the rush?” And eventually I said, “No, I’m on annual leave at the moment my first day back at work tomorrow, so can I come in on Thursday?” And they said, “Oh, OK.”

 

In some cases people said they had a general awareness of what might be happening and so were more inclined to make the call to the GP more quickly. Martyn rang the GP himself as he had an idea that his symptoms might indicate a TIA (see ‘Medication, treatment and surgery’).
 

Martyn experienced a short episode of numbness and tingling in his arm and shoulder whilst at...

Martyn experienced a short episode of numbness and tingling in his arm and shoulder whilst at...

Age at interview: 64
Sex: Male
Age at diagnosis: 57
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Well, it was funny, we were planning the Christmas carol service I think and I must have either read something or been aware of TIAs and mini-strokes and all the rest of it, and these vascular problems and so, me, my consciousness was heightened of it and I didn’t really, I’m still not actually sure whether it was a TIA or that I was sitting very badly on the chair, and I was chairing a small meeting, there were four or five of us in my office and my body was twisted right round. And my shoulder, and all my weight was on my right arm. And the tingling I had was in my right arm. That I do remember. But the hearing was strange, so maybe it was a TIA, maybe it wasn’t, I don’t know.
 
I rang, I rang my local surgery, yeah. I worked in [local town] and I live in [different local town] and I contacted the surgery which is down the road here at [local area] and put me through and he said, “Could be a TIA, take an aspirin”.

 

In many cases it was a partner, friend or relative who called for help. Typically this was where the person experiencing symptoms was unable to communicate, or had collapsed. Rosemary was prompted to call an ambulance when her husband Brian (Interview 08) woke from a nap complaining that his vision was blurred and he was feeling dizzy and somewhat disorientated. Rosemary called for help sooner rather than later because since her husband’s heart attack she had been told if in doubt to call the paramedics immediately.
 

Rosemary feels it’s very important to seek help for someone when they are experiencing...

Rosemary feels it’s very important to seek help for someone when they are experiencing...

Age at interview: 73
Sex: Female
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I think very important to sort of notice what’s going on, if someone is having an attack of any kind, is that the person it’s happening to quite often will say, “Look, it’s nothing. I, leave it. Let’s see what tomorrow’s like.” But, in my opinion, don’t do this. If you’re worried, concerned that something’s happening do seek help straight away.

 

When Geoff woke up one night feeling that he was going to be sick, it became evident to Enid his wife that he was also unable to move. Realising that he needed help straight away Enid called the GP, who recognised the urgency and arranged for an ambulance to take Geoff to hospital where he was assessed and immediately admitted for treatment.
 

Enid rang the doctor as soon as she realised that Geoff was unwell...

Enid rang the doctor as soon as she realised that Geoff was unwell...

Age at interview: 68
Sex: Male
Age at diagnosis: 65
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Geoff' Early Friday morning I was in bed, about to get up and now I just sat up in bed and I just lost all consciousness. And the next thing I realised I was being put in a, in a little chair to be taken in an ambulance. And then the next thing I, I know I was, had, had the medical examination in [local hospital].
 
So can, maybe Enid can fill in some gaps there, what happened? What did you know to …?
 
Enid' Well, he woke me up by making a funny noise. And I said, “Geoff are you all right?” And he said, “No.” So I got out of bed and ran around the bed and I said, “What’s to do?” He said, “I don’t know.” But he wasn’t sat up. He was on his back. And he said, “I’m going, I think I’m going to be sick.” So I said, “Well, if you’re going to be sick, you’ll either have to sit up or get on your side or else you’re going to choke.”
 
Geoff' No, I don’t remember any, any of that.
 
Enid' Now he said, “I can’t.” So I realised then he was paralysed.
 
Geoff' So, I got me….
 
So, you then…?
 
Enid' …I rang the doctor first and then she sent an ambulance. And they rushed him to the hospital. They were very, very good actually the paramedics that came.
 
So, Geoff, perhaps you could carry on with your story now?
 
Geoff' So when, I came round after being examined in hospital and there was just wait, they were, the. It was a doctor, was it?
 
Enid' I think you were about two hours before you came round.
 
Geoff' They were trying to find me, find a place to take me, weren’t they?
 
Enid' They asked you some questions before that. And asked you if you knew where you were and if you knew what had happened. And you just said, “I’ve had a funny do.” And they said, “Where are you?” He said, “[local hospital].” That’s the hospital in [town] because we used to live in [town].
 
Enid' So they said, “Where are you?” And he said, “I’m in hospital in …
 
Geoff' “I’m in hospital.”
 
So he knew what was going on at that point?
 
Enid' He knew what going on then. Yes.
 
Yeah.
 
Enid' But I bet it was about two hours before he actually came round.
 
Geoff' Yeah I don’t, I don’t remember anything.
 
Enid' Because I don’t remember them doing like they do on your knee you know to see if you have any reaction.
 
Geoff' Yeah.
 
Enid' But when you spoke they said that was a good sign.
 
OK. So then what?
 
Geoff' So that.
 
When, when you did start remembering, what, what was, what can you remember now?
 
Geoff' I remember taking, me, taking me out of the emergency department and…
 
Enid' Took you to another ward.
 
Geoff' They took me down to put me on a ward, which was down the road and out of the, the building where we were, and across and into another building. And they put me into bed there. 

And that’s where I stayed.

Enid: Until he came home. 

Geoff: How long was I in?

Enid: Nearly a fortnight. Well, it happened on the 27th of July and it was the beginning of August when you came out. 
 
When Adrian had a TIA at home one evening, his partner recognised what she thought were the symptoms of stroke from having seen the ‘FAST’ campaign advert on TV (FAST stands for ‘Face, Arms, Speech – Time to call 999’). She called the ambulance straight away and paramedics arrived at home where he was assessed before being taken to hospital.
 
 

Adrian’s partner recognised the symptoms of stroke from seeing the FAST TV advert and immediately...

Adrian’s partner recognised the symptoms of stroke from seeing the FAST TV advert and immediately...

Age at interview: 53
Sex: Male
Age at diagnosis: 53
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She recognised because the face, the FAST thing on the television, the advert on the TV and that’s the only way she would have known. And that’s the first thing she said to the paramedic. If she hadn’t seen that advert she wouldn’t have known what was going on, and then it clicked in her mind straight away. So that absolutely, that advert works absolutely perfectly.
 
And which bit of that was it that rang bells with her?
 
All of it. It was the, when my face dropped and my speech began, apparently I was starting to make funny noises. And she said that clicked in straight away and that’s why she reacted the way she did. And she was at, one minute slightly torn between leaving me and getting the telephone to get on to the ambulance, but, she’d remembered that advert, and it obviously works and its it does its job. It’s really good.
 
And I was going to ask you what was going through your mind during that period of time?
 
My fear was that I was going to be unable to communicate, that I’d lose the ability to be able to talk to my partner. That I’d be unable to work.
 
Losing my arm, not being able to move my limb was a horrific thought. And it was the lack of communication is the worst thing. Because... that’s a big part of your personality as well, your voice, and, your communication skills. And I was, it really did scare me. And the thought of not being able to talk to somebody that you love. It really, it really is quite horrific.
 
And you say over all the symptoms lasted for approximately how long?
 
Half an hour, twenty minutes. May be a little bit. But... possibly three quarters of an hour at the most. But by the time, certainly by the time you got to the [hospital] I felt like a fraud, because I was feeling perfectly fine.
 
Really?
 
And all the symptoms had disappeared. But they were very good at the [hospital] as well, I have to say.
 
Talk me through what happened when you went there?
 
Straight in A & E... a nurse came and done an assessment. Pushed on my arms and legs, took my blood tests, done all the usual things, blood pressure, temperature. And I sat there for a while my partner turned up, my eldest son turned up. And the doctor came in and done all the relevant checks again, and had a little chat about past history, about my heart condition. Basically, he said, “You’re fine.” And sent me off with a handful of tablets, these super aspirin tablets to make sure I didn’t get another blood clot. And... said that he’d book me in for the outpatients.

 

While several people said the FAST campaign had helped them be alert to possible symptoms, those with visual disturbance or a feeling of disorientation did not necessarily make the connection between their symptoms and FAST.
 
In most cases where an ambulance was called, the person was examined at home by the paramedics, and then usually taken in to A&E to be assessed (see Adrian above). One woman collapsed in the supermarket and a supervisor called for an ambulance. Some people we talked to were able to go home straight away, but others stayed in hospital.
 
Some people said they did not want to stay in hospital and were reluctant to be admitted. Adrian (above) said he had been glad that he was able to return home as he hated hospitals. Clare had been taken ill at work and a colleague had called for an ambulance. She was taken to hospital and was admitted overnight.
 

Clare wanted to go home that evening but the doctor insisted she stayed in hospital overnight.

Clare wanted to go home that evening but the doctor insisted she stayed in hospital overnight.

Age at interview: 50
Sex: Female
Age at diagnosis: 48
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Were you admitted to hospital? Did you stay in or did you…?
 
I didn’t want to stay in. I begged the consultant to let me out. But he wouldn’t have it. They wanted me to lie on my back for 24 hours I think it was, it was something to do with fluid, fluid to the brain…
 
… they wanted me to have fluid to brain so they refused me to be lot home. And they said, “If you lived on your own you wouldn’t be allowed out anyway.” But luckily I was married, so...
 
You just stayed in overnight?
 
I had to, yeah. They wouldn’t let me out.

 

 

Keith stayed in hospital overnight but was keen to get home as soon as possible. On discharge he...

Keith stayed in hospital overnight but was keen to get home as soon as possible. On discharge he...

Age at interview: 58
Sex: Male
Age at diagnosis: 58
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And then the ambulance came and two paramedics came in who were absolutely wonderful. Walked in and, and took control and, I actually walked to the ambulance which was at the front of the house, speaking to the paramedics as I went. Lay down in the ambulance and talked to them all the way through. And then went into the hospital…
 
So I was taken to the hospital instantly taken and, and seen and the rest of the evening is a bit of a blur really. There were a whole series of tests, different people came in to see me, question me about various things. And I felt good. I felt pretty desperate to get out. I want, I didn’t want to be in hospital, you know, my natural reaction was to get out almost at whatever cost really. I didn’t want to be there. But the help I had was terrific, terrific support, terrific talking me through every stage and, and what the tests were for. And my wife and son came with me and, and kept me company while I was there and waited for about three hours I suppose, three and a half hours. I went into hospital at six o’clock the ambulance picked me up. And by half past nine I came home. Stayed overnight, felt tired, stayed overnight but with an appointment to go back to the hospital the following day at mid-day.

 

Not everyone was satisfied with the way they were dealt with when they were assessed in A&E. Gilly was taken to A&E by her colleague after collapsing at work, and although the emergency doctor she saw there thought it possible that she had had a TIA she was discharged and referred to a generalised clinic specialising in ‘unexplained events’ rather than one that dealt specifically with strokes.
 
In Gillian’s case it was felt initially that she might have a urine infection, and the next day when she saw her GP and the tests came back clear she was told that no further action was needed. However Gillian felt that it was important to know what had happened to her so that she could get a diagnosis and treatment.
 

Gillian was seen by her doctor the day after the episode and she was given a ‘non urgent’...

Gillian was seen by her doctor the day after the episode and she was given a ‘non urgent’...

Age at interview: 92
Sex: Female
Age at diagnosis: 90
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Oh yes she came and we talked about it and she didn’t think I’d had a stroke. She thought I’d had a urinary infection. And they did all the tests for that, tested urine and the blood and that was that. So there wasn’t, it was quite normal, what I said myself, Well, they said no action, no further action needed to be taken. So I said, “It certainly does need to be taken because I need to have a diagnosis and treatment”.
 
Well then nothing else happened until I went to the hospital.
 
And so what period of time had gone, a couple of weeks did you say? Between the doctor and…
 
About a couple of weeks.

 



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Last reviewed June 2017.
Last updated August 2013
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