MINNEAPOLIS — Transient ischemic attacks (TIAs), commonly described as mini-strokes, have long been understood as acute, temporary disruptions of cerebral blood flow that resolve within 24 hours without permanent neurological damage. However, emerging research is challenging the traditional perception of TIAs as purely transient events without long-term consequences. A groundbreaking study published online on May 14, 2025, in the journal Neurology, the flagship publication of the American Academy of Neurology (AAN), presents compelling evidence that individuals who experience TIAs may suffer from persistent fatigue lasting up to one year post-event.
The pathophysiological mechanisms underlying TIAs involve a temporary blockage in the cerebral vasculature, typically caused by microemboli or transient thromboses that restrict perfusion to brain regions. Although these blockages resolve rapidly, the study led by Dr. Boris Modrau at Aalborg University Hospital in Denmark reveals that the biochemical and neuropsychological sequelae triggered by TIAs may extend far beyond immediate symptom resolution. This research focuses specifically on fatigue, a multifaceted and debilitating symptom frequently reported by patients following cerebrovascular incidents.
In this prospective longitudinal study, 354 TIA patients with a mean age of 70 years were meticulously followed over a 12-month period. Fatigue assessment was conducted using a specialized questionnaire designed to capture distinct dimensions of fatigue including global tiredness, physical exhaustion, reduction in activity levels, motivational decline, and cognitive fatigue. The questionnaire’s scoring system ranged from 4 to 20, with scores above 12 indicating clinically significant fatigue. Initial evaluations taking place within two weeks of the TIA disclosed an average fatigue score of 12.3, affirming that a considerable proportion of patients were experiencing moderate to severe fatigue shortly after the ischemic episode.
Over the course of the study, sequential fatigue assessments were carried out at three, six, and twelve months. Interestingly, the average fatigue score demonstrated only a slight downward trend, with scores measured at 11.9, 11.4, and 11.1 respectively, suggesting that for many patients, fatigue is a persistent and chronic symptom rather than a transient post-stroke complaint. Furthermore, the prevalence of fatigue among participants remained remarkably high; 61% reported fatigue two weeks post-TIA and approximately 54% sustained this fatigue at all subsequent timepoints, underscoring the enduring nature of this symptom.
Magnetic resonance imaging (MRI) and other brain imaging modalities were employed to explore structural and ischemic correlates of fatigue; however, the presence and size of blood clots seen on imaging did not significantly differ between patients who reported long-term fatigue and those who did not. This finding indicates that the severity or location of ischemic lesions does not fully account for the persistence of fatigue post-TIA, pointing researchers toward alternative pathophysiological or psychosocial mechanisms.
One of the most salient findings of the study was the identification of pre-existing psychiatric conditions such as anxiety and depression as significant predictors of prolonged fatigue. Patients with a documented history of anxiety or depression were twice as likely to report persistent fatigue one year following their TIA, suggesting a strong interplay between neuropsychiatric health and stroke recovery. This association underscores the importance of holistic neuropsychological assessment and management in individuals experiencing TIAs.
Chronic fatigue after TIA poses a substantial burden on patients’ quality of life, impacting cognitive function, emotional well-being, and day-to-day activities. According to Dr. Modrau, these findings highlight the necessity for clinical vigilance and proactive screening for fatigue symptoms in the acute aftermath of a TIA. Early identification and targeted intervention may mitigate the risk of prolonged disability and improve functional outcomes.
The study was not without limitations; participants self-reported fatigue via standardized questionnaires which, although validated, are inherently subjective. Some individuals may have received assistance from caregivers or relatives, potentially biasing responses. Despite these constraints, the study presents a robust dataset replete with repeated measures over an extended follow-up period, providing unprecedented insight into the longitudinal course of fatigue in TIA patients.
Future research directions emerging from this study include elucidating the biological basis of post-TIA fatigue. Hypotheses suggest that systemic inflammatory responses, microvascular dysfunction, alterations in neurotransmitter systems, or dysregulation of the hypothalamic-pituitary-adrenal axis may contribute to persistent fatigue. Moreover, the psychosocial context, including mood disorders and social support networks, warrants further investigation to develop comprehensive multidisciplinary care models.
The continuation of fatigue symptoms beyond the acute phase of TIA challenges traditional clinical paradigms and necessitates an expansion of stroke rehabilitation protocols to encompass neuropsychiatric and psychosocial dimensions. With more than 40,000 members worldwide, the AAN is at the forefront of advancing clinical practices that integrate research findings such as these into patient care and education.
This study opens the door for neurologists and other healthcare providers to adopt a more nuanced approach in managing TIA patients, emphasizing the importance of post-discharge follow-up that routinely screens for fatigue and related neuropsychological symptoms. Such comprehensive care strategies will be pivotal in improving long-term outcomes and enhancing the quality of life for millions of individuals affected by cerebrovascular events.
In conclusion, the evidence presented by this study significantly reframes our understanding of transient ischemic attacks, illustrating that the consequences of these so-called “mini-strokes” may be more enduring and complex than previously appreciated. The recognition of fatigue as a prevalent and persistent symptom up to one year post-TIA invites further research and clinical innovation to better support this vulnerable patient population.
Subject of Research: Fatigue following transient ischemic attack (mini-stroke)
Article Title: Information not provided
News Publication Date: May 14, 2025
Web References: https://www.neurology.org/journal/wnl
Keywords: Health and medicine, Human health, Transient ischemic attack, Mini-stroke, Fatigue, Neurology, Cerebrovascular disease, Brain health, Stroke, Anxiety, Depression
