Can stress cause a Transient Ischemic Attack (TIA) or mini stroke?

From the Guidelines

Stress can contribute to a Transient Ischemic Attack (TIA) but is typically not a direct cause on its own. Stress increases blood pressure and heart rate, which can potentially dislodge existing plaque in arteries or promote blood clot formation that may temporarily block blood flow to the brain, resulting in a TIA. The primary risk factors for TIAs include high blood pressure, atherosclerosis, heart disease, diabetes, smoking, and age. If you're concerned about TIA risk, focus on managing these underlying conditions with appropriate medications (such as antihypertensives for high blood pressure or statins for high cholesterol) and lifestyle modifications. Some key points to consider:

• The risk of stroke following a TIA is high, with 8.8% at 7 days and 11.6% at 90 days 1.
• The evaluation of patients with clinical carotid TIA or minor stroke requires rapid vascular imaging of the cervical carotid arteries in addition to brain parenchymal imaging 1.
• Stress management techniques like regular exercise, adequate sleep, meditation, and deep breathing can help reduce stress levels and may indirectly lower TIA risk by improving overall cardiovascular health. However, if you experience TIA symptoms such as sudden weakness, numbness, speech difficulties, or vision problems, even if brief, seek immediate medical attention as TIAs can be warning signs of a future stroke. It's also important to note that the relationship between blood pressure and stroke is continuous, with a 30% to 45% increase in stroke risk for each 10-mm Hg increase in blood pressure 1. Antihypertensive therapy can reduce the risk of stroke, with a 33% decreased risk of stroke for each 10-mm Hg reduction in systolic blood pressure to 115/75 mm Hg 1. Given the high risk of stroke following a TIA, it's essential to prioritize managing underlying conditions and reducing stress levels to minimize the risk of a future stroke.

From the Research

Stress and Transient Ischemic Attack (TIA) or Mini Stroke

• Stress can increase the risk of heart attack and stroke, although the exact mechanism is unknown 2
• There is an evident association between both acute and chronic emotional stress and risk of stroke, with several potential mechanisms discussed, including modulating symphaticomimetic activity, affecting blood pressure reactivity, cerebral endothelium, coagulation, or heart rhythm 3
• Acute psychological stress is a potential independent triggering factor for the occurrence of stroke, with a study showing that acute psychological stress was associated with transient increased odds of stroke in the subsequent 2 hours 4
• Hypertension, which can be exacerbated by stress, is a major risk factor for stroke and can cause stroke through various mechanisms, including endothelial damage, altered blood cell-endothelium interaction, and degenerative changes in smooth muscle cells and endothelium 5, 6
• The relationship between stress and stroke is complex, and further studies are needed to fully understand the mechanisms underlying this association 3, 4

Key Findings

• Stress can increase the risk of stroke, including Transient Ischemic Attack (TIA) or mini stroke
• Acute and chronic emotional stress are both associated with an increased risk of stroke
• Hypertension is a major risk factor for stroke, and stress can exacerbate hypertension
• Further research is needed to fully understand the mechanisms underlying the relationship between stress and stroke 2, 3, 4