Mini-Stroke (TIA) Warning Signs: The Stroke That Starts in Your Neck

Vascular EducationClinic Updates
Written By Andrew Choong

Today is World Stroke Day. One in four of us will have a stroke in our lifetime, and some of the most preventable ones do not start in the brain at all. They start in the carotid arteries of the neck. In this short video I explain the warning signs, why a mini-stroke that passes within minutes is a warning rather than a reprieve, and what a vascular surgeon can do about a narrowed carotid artery before the stroke happens.

Published 29 October 2026 · 1 min 21 sec · Watch on YouTube · Video page

If someone has stroke symptoms now, call 995. If the symptoms came and went, go to an emergency department today, even if they feel entirely well.

What I say in the video

One in four of us will have a stroke in our lifetime. And some of the most preventable ones don't start in the brain. They start in your neck. I'm Dr Andrew Choong, vascular surgeon in Singapore, and today is World Stroke Day.

First, know the signs. Think FAST. Face drooping, arm weakness, slurred speech, time to call 995, and watch for the sudden loss of vision in one eye. Sometimes these symptoms go away within minutes. That's a mini stroke and it's a warning.

Often the cause is your carotid arteries, which carry blood up the neck to the brain. Cholesterol plaque builds up inside them and a piece can break off and block an artery in the brain. A simple ultrasound scan of the neck shows if an artery is narrowed. If it is, we can remove the plaque through a small cut in the neck or hold the artery open with a stent. The benefit is greatest in the first two weeks.

So, especially if the signs and symptoms go away, go to the emergency department today. Think FAST. Every minute counts.

What are the warning signs of a stroke?

The FAST check covers the commonest signs. Face: has one side dropped, or is the smile uneven? Arms: can both be raised and held up? Speech: is it slurred, muddled or missing? Time: if any of these appear, call 995 at once. Sudden loss of vision in one eye, like a curtain coming down, is a fifth sign that people often overlook, and it points towards the carotid artery on that side. I cover the signs in more detail in my stroke warning signs video.

What is a mini-stroke (TIA)?

Sometimes the same symptoms last a few minutes and then disappear. That is a transient ischaemic attack, or TIA: a clot reached the brain and happened to dissolve before it caused permanent damage. It is tempting to put it down to tiredness or a bad night and carry on. It is in fact one of the clearest warnings the body gives. The risk of a full stroke is highest in the first days and weeks after a TIA, which is why the symptoms going away is a reason to be seen today, not a reason to wait. I wrote about exactly this ahead of World Stroke Day in a letter to The Straits Times Forum, and for readers in Malaysia and Cambodia.

Why can a stroke start in the neck?

The two carotid arteries run up either side of the neck and carry most of the blood supply to the brain. With age, smoking, high blood pressure, diabetes and high cholesterol, plaque builds up inside them, just as it does in the arteries of the heart and legs. The danger is not usually that the artery blocks off completely. It is that a fragment of plaque breaks away, travels up with the blood flow and lodges in a smaller artery inside the brain. The carotid artery disease page explains the condition in full, and my earlier video on TIA and carotid artery disease goes through the link step by step.

How is a narrowed carotid artery found?

With a carotid duplex ultrasound: a painless scan of the neck that takes about twenty minutes, needs no injection and no radiation, and shows how narrow the artery is and what the plaque looks like. In my clinic at Mount Elizabeth Novena the scan is done in the vascular ultrasound laboratory at the same visit, so a patient who has had a TIA does not wait for a second appointment to learn whether the carotid artery is the cause. There is a short video on what a duplex ultrasound involves.

What can be done about it: carotid endarterectomy or a stent?

If the scan shows a severe narrowing on the side that caused the symptoms, treating it lowers the risk of a major stroke. There are two ways. A carotid endarterectomy removes the plaque through a small incision in the neck. A carotid stent holds the artery open from the inside, placed through a small puncture rather than an incision. Which one suits a particular patient depends on the shape of the plaque, the neck, the heart and the person's other conditions; both are described on the carotid surgery and stenting page. Alongside either procedure, the medicines matter: an antiplatelet, a cholesterol-lowering medicine and good blood pressure control.

Why do the first two weeks matter so much?

Because the benefit of treating the carotid artery is greatest early. In the pooled analysis of the major carotid surgery trials, five patients needed surgery within two weeks of their symptoms to prevent one stroke; after twelve weeks the number was 125. The operation is the same; what changes is how much it can still prevent. That is the reason I review TIA patients the same day where a carotid cause is suspected, and the reason a referring doctor should treat transient face, arm, speech or one-eye visual symptoms as a same-day problem rather than a routine appointment. Colleagues will find the practical details on the referring doctors page.

What should I do if the symptoms have already gone?

Go to an emergency department the same day, even if you feel completely well. In Singapore, call 995 for an ambulance if symptoms are happening now. Take a note of what happened, which side was affected, how long it lasted and what time it started: those details help the doctor who sees you. If a scan has already shown a narrowed carotid artery and you would like a vascular surgeon's opinion on it, bring the scan report and images, a list of your medicines and any recent blood tests. Patients travelling from overseas will find practical details on the international patients page, and the clinic can be reached through the contact page.

More on stroke and the carotid artery

This video and post provide general information and do not replace individual medical advice. For a medical emergency in Singapore, call 995.

Andrew Choong
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