Tiredness That Won't Go Away? It Might Have Been a Small Stroke

Even after recovering from a transient ischemic attack (TIA), more than half of patients continue to experience severe fatigue for up to a year. This fatigue is not linked to visible brain damage, but is more common in people with a history of anxiety or depression. If fatigue appears in the first few weeks after a TIA, it is likely to persist, highlighting the importance of providing ongoing support to patients.

A transient ischemic attack (TIA) is a neurological condition characterized by temporary symptoms similar to those of a stroke, but which resolve within 24 hours, leaving no apparent permanent damage to the brain.

However, more recent research has revealed that, even after physical recovery, many patients continue to experience difficulties that affect their well-being, such as intense and persistent fatigue.

This fatigue can be debilitating and compromise quality of life, making it difficult to return to normal activities. Despite this, there is still little knowledge about who is most likely to develop this condition after a transient ischemic attack, which makes it essential to study its progression and identify risk factors.

Transient Ischemic Attack

In this study, researchers monitored patients who had suffered a transient ischemic attack, with the aim of better understanding how fatigue evolves over time, especially up to one year after the episode.

A total of 354 patients diagnosed in a specialized stroke unit (CVA) were included. Of these, 287 answered questionnaires that assessed fatigue at different times: 14 days after discharge (considered the starting point), and then at 3, 6 and 12 months.

To do this, they used two specific tools: the Multidimensional Fatigue Inventory (MFI-20), which measures different aspects of fatigue (such as general, physical and mental fatigue), and the Fatigue Severity Scale.

Right from the start, the results showed that more than half of the participants (approximately 61%) already had levels of fatigue considered pathological, that is, fatigue that is intense and interferes with daily functioning.

Even after a year, this number remained high: more than 53% still reported significant fatigue. This shows that although TIA is seen as a temporary condition, the subjective effects can be long-lasting. Furthermore, average fatigue levels only decreased slightly over the months.

When investigating possible factors related to persistent fatigue, the researchers noted that there was no significant difference in the presence of acute infarction (small lesions in the brain caused by lack of blood). This indicates that fatigue is not necessarily linked to visible brain damage.

On the other hand, they observed that people with a history of anxiety or depression were twice as likely to develop fatigue after TIA. This suggests a significant relationship between pre-existing mental health and post-TIA symptoms.

The authors also built statistical models to try to predict which patients would continue to have fatigue after 12 months. They found that the level of fatigue shortly after hospital discharge was the main predictor of whether fatigue would persist. In other words, if a person still felt very tired two weeks after a transient ischemic attack, there was a good chance they would continue to feel that way up to a year later.

This finding is important because it could help doctors identify patients early on who will need long-term monitoring and support.

In summary, the study shows that pathological fatigue is a common and often overlooked consequence of a TIA. This condition can last for at least a year and significantly impacts people’s lives, even if there is no detectable brain damage.

Patients who already deal with anxiety or depression appear to be at higher risk, and symptoms of fatigue soon after hospital discharge are a strong warning sign. These findings highlight the importance of more careful follow-up after TIA, not only focusing on physical recovery, but also on the patient’s mental well-being and energy.

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Long-Term Fatigue Following Transient Ischemic AttackA Prospective Cohort Study

Birgitte Hede Ebbesen, Simon Grøntved, Jakob Nebeling Hedegaard, Søren P. Johnsen, Jane Andreasen, Krystian Figlewski, Mirko Porobic, Michael Skovdal Rathleff, and Boris Modrau

Neurology. June 10, 2025 issue 104 (11)

DOI: 10.1212/WNL.0000000000213605

Abstract:

By definition, patients with transient ischemic attack (TIA) should not have residual symptoms beyond 24 hours. However, preliminary evidence indicates lasting challenges such as fatigue. It is unknown who develops fatigue, and the extent. This knowledge is required to develop evidence-based support for patients. We aimed to explore fatigue up to 12 months after TIA and determine what characterizes patients who experience pathologic fatigue. This is a prospective cohort study including patients with TIA diagnosed at a specialized stroke unit. Fatigue was measured using Multidimensional Fatigue Inventory (MFI-20) and Fatigue Severity Scale at 14 days (baseline) and 3, 6, and 12 months after discharge. The association between candidate prognostic factors and fatigue at 12 months was tested using linear regression models. We compared model performances using likelihood ratio (LR). We included 354 patients, of which 287 provided baseline responses (mean age 70.0 ± 11.1, 42.5% female). At baseline and 3, 6, and 12 months, the mean level of general fatigue on MFI was 12.3 ± 4.6, 11.9 ± 4.6, 11.4 ± 4.5, and 11.1 ± 4.5 and the proportion with pathologic fatigue (≥12 on the MFI-20 General Fatigue) was 61.3%, 53.5%, 54.0%, and 53.8%, respectively. The prevalence of acute infarction was evenly distributed between patients who reported fatigue and those who did not. Previous anxiety/depression was twice as common in the group that reported fatigue. The model including baseline level of fatigue, sex, age, and acute infarction was able to explain variability in the reported data to a statistical significantly higher extent, compared with the model only including sex, age, and acute infarction (p < 0.001, LR = 387.30). Pathologic fatigue is common up to 12 months after TIA diagnosis. If patients report fatigue within 14 days after discharge, it is likely that this remains until 12 months. We found no indication of an association between the presence of acute ischemic lesions and fatigue. The prevalence of previous anxiety/depression was higher in the group that reported fatigue.