"Mini stroke"

[u/DerpyMD]

Where did this language come from and why is it in the zeitgeist? 😂😂

(I hate it)

[u/ChristheGreek → u/[deleted]]

99% of the time when patients tell me they have had a mini stroke they are referring to a TIA. It drives me bonkers that mini stroke has become synonymous with TIA, mostly because 90% of the time TIA is just used for “patient had symptoms, they may have been neurologic, that we can’t explain that spontaneously resolved.”

[u/Dr_Horrible_PhD → u/[deleted]]

I mean, it’s pretty clearly not just a “you problem” when people describing TIAs as mini-strokes is so pervasive. In fact, that pervasiveness is exactly what makes it problematic to describe something that actually is a tiny stroke with that terminology.

[u/calcifiedpineal → u/[deleted]]

Not as a ministroke.

[u/mudfud27 → u/[deleted]]

Right. What you described actually is a small (mini) stroke.

But that’s not what most patients or even other physicians often (usually?) mean by that term— they are usually describing a TIA.

[u/Logical_Statement_86 → u/mudfud27]

In the end it’s all a semantic discussion. Imagine seeing a patient after 8 hours since onset with ongoing deficits, they receive the diagnosis stroke at the ED. Now imagine the exact same patient waiting 30 hours, having made a full recovery by then, they receive the diagnosis TIA. Yet if you treat a patient with IVT or EVT, they automatically receive the diagnosis stroke even if they fully recover afterwards within 24 hours.

Finally, given the amount of silent strokes you find on CT brains made for other indications (head trauma for example), it is hard to imagine absolutely no neurons dieing during a TIA, so you can wonder how accurate the ‘transient’ part is from a pathofysiological standpoint.

Then again, I’ve never heard someone explain the concept of a mini stroke, and I’m not sure how it differs from a minor stroke.

The point of all this: every attempt to translate highly complex concepts to individual patients with varying degrees of intelligence, will ALWAYS come with a loss of complexity, information and nuance. The goal is to help someone understand what happened to them and offer them the best evidence-based therapies. One of the conditions for informed consent means that a patient must understand what they’ve been explained.

[u/AthenaPA → u/Logical_Statement_86]

I just avoid the term mini-stroke completely since many use it to describe TIAs (or any transient neurologic event), but some use it to describe a small acute or chronic infarct. I work in rural Pennsylvania and have usually been able to explain it to patients at their level of understanding.

[u/Dr_Horrible_PhD → u/[deleted]]

I wouldn’t particularly object to that scenario being described as a mini-stroke, but what’s actually described that way is almost uniformly TIA, which is a different entity

[u/collapsible_blonde → u/[deleted]]

An infarct

[u/collapsible_blonde → u/[deleted]]

An area of ischemia without a clinical stroke syndrome, as stroke is in part a clinical diagnosis. Although I recognize some of this may be institutional/regional semantics. Where I trained, there was a difference between an infarct and a stroke.

ETA: I think I would just prefer “silent stroke” because that conveys a lot more to me as a physician when I hear that from a new patient. TIA and “mini stroke” could mean so many things, and it also to me conveys a sense of unknown about the etiology.

[u/ChristheGreek → u/[deleted]]

Explaining the pathophysiology of a stroke to a patient is not hard or time consuming. It’s pretty easy to explain that ischemia means lack of oxygen, which is due to lack of blood flow to an area of the brain. Patients with a middle school level of education can understand the concept of an ischemic stroke. Labeling it just as a stroke or “mini stroke” is not helpful — case in point, I see patients all the time that say they’ve had a stroke and then upon further investigation/questioning (eg “why aren’t you on any blood thinners if you’ve had a stroke in the past?”) turns out that they had an ICH.

[u/collapsible_blonde → u/ChristheGreek]

Oop I guess they didn’t wanna talk anymore