Pay Attention to the Mini-Stroke That Seems to Go Away
World Stroke Day falls on Thursday, 29 October. Ahead of it, The Straits Times published my letter in its Forum section on 25 October 2026. It is about the stroke that seems to go away. The letter is reproduced below, followed by a few answers to the questions patients most often ask about it.
The letter
World Stroke Day falls on Oct 29. Most of the attention it brings will rightly go to recognising a stroke and calling 995 at once. As a vascular, endovascular, and aortic surgeon, I want to draw attention to the stroke that seems to go away.
A transient ischaemic attack – often called a mini-stroke – produces the same signs as a stroke: a drooping face, a weak arm, slurred speech, loss of vision in one eye. The difference is that the symptoms resolve, sometimes within minutes. People are relieved, put it down to tiredness or low blood sugar, and carry on with their day.
That relief is misplaced. A transient ischaemic attack means a clot has already reached the brain and happened to dissolve. The next one may not. The risk of a full stroke is highest in the first days and weeks afterwards.
The encouraging part is how much that risk can be reduced.
In a study from Oxford published in The Lancet, patients assessed and treated within a day of a transient ischaemic attack had an 80% lower chance of a stroke in the following three months than those seen through the usual appointment system. Few treatments in medicine deliver a result of that size, and it depends almost entirely on speed.
Part of that assessment is a look at the carotid arteries in the neck, which carry blood to the brain. When one of them is narrowed by cholesterol plaque, fragments can break away and lodge in the brain. Where that is the cause, treating the narrowing promptly prevents further strokes, and the benefit is greatest in the first fortnight.
According to the World Stroke Organisation, more than 100 million people alive today have had a stroke, one in four adults over 25 will have one in their lifetime, and over 80% of strokes are associated with risk factors that can be identified: high blood pressure, diabetes, smoking, high cholesterol and an irregular heartbeat.
If you or someone near you has stroke symptoms that pass, do not wait to see whether they come back. Go to an emergency department the same day, even if you feel entirely well. The brief episode that went away is the best warning the body will give.
Andrew Choong
First published in The Straits Times Forum, 25 October 2026.
What is a transient ischaemic attack?
A transient ischaemic attack, or TIA, is a brief interruption of blood supply to part of the brain or the eye. It causes the same signs as a stroke, such as a drooping face, a weak arm, slurred speech or loss of vision in one eye, but the symptoms pass, often within minutes. Because they pass, many people never seek help. A TIA is a warning that a clot has already reached the brain and that a full stroke may follow.
Why does speed matter so much?
The risk of a full stroke is highest in the first days and weeks after a TIA. In the Oxford study published in The Lancet, patients assessed and treated within a day had an 80% lower chance of a stroke over the following three months than those seen through the usual appointment system. That is why the advice is to go to an emergency department the same day, even if you feel entirely well.
Where do the carotid arteries come in?
The carotid arteries in the neck carry blood to the brain. When one is narrowed by cholesterol plaque, fragments can break away and lodge in the brain, causing a TIA or a stroke. A duplex ultrasound scan shows whether a carotid artery is narrowed and by how much. Where a narrowing is the cause of symptoms, treating it promptly prevents further strokes, and the benefit is greatest in the first fortnight. The condition and its treatment are explained on the carotid artery disease page.
Who is at risk?
According to the World Stroke Organisation, one in four adults over 25 will have a stroke in their lifetime, and over 80% of strokes are associated with risk factors that can be identified: high blood pressure, diabetes, smoking, high cholesterol and an irregular heartbeat.
What should I do if it happens to me or someone I love?
If the symptoms are happening now, call 995. If they have already passed, do not wait to see whether they come back: go to an emergency department the same day. Afterwards, if you have been told you have a narrowed carotid artery, or would like a second opinion on one, details are on the contact page. This letter and my other published pieces are listed on the press page.