For most of us with busy lives it's quite common to feel under the weather sometimes – faint, dizzy, exhausted or weak. Usually it's a passing disturbance, caused by stress, an infection or not enough sleep. But it can be a terrible, and sometimes fatal, mistake to dismiss such episodes as "just a funny turn". For 46,000 people each year, these symptoms are caused by a TIA – a transient ischaemic attack – which is a mini-stroke. If not taken seriously, there's a real risk of a full stroke happening.
I now know a lot about TIAs, but knew nothing two years ago. That's when my husband, the broadcaster Andrew Marr, had a couple of "funny turns" but thought they were nothing serious. A few months later he went on to have a major, life-changing stroke, which resulted in four months in hospital; eight months off work and permanent disability.
We only realised that he had had a couple of TIAs when the hospital surgeon told him that brain scans revealed two earlier "incidents" before his full stroke. At first we were puzzled, but then realised that the clues were there.
In retrospect, Andrew's most obvious TIA happened while he was filming for a BBC history series in northern Greece. He got up early one morning to do a piece to camera in a cave in Macedonia and, most unusually for him, simply couldn't get the words out.
He told me his mouth just stopped working and he had an overwhelming sensation of tiredness. He was helped into the crew car and left to sleep for the afternoon in a local village, after which he felt better and was able to complete filming. At the time he put it down to jet lag (he had been crossing several different time zones during the course of the filming, travelling to Japan, China, the US and Russia.)
A month or so later, when back in the UK, he blacked out briefly and couldn't understand why. This time he was alone, and so wasn't aware of any speech difficulties. Again, the episode passed off quite quickly and he thought no more of it. After all, he was only 53 and kept himself fit with regular long runs and cycle rides around Richmond Park. If only we had recognised what was going on, Andrew could have had help before his stroke happened. But he didn't understand it, and neither did I.
What was in fact taking place was that a small clot was blocking the blood supply to the brain. In most cases of TIA, the blockage either dissolves itself or moves, so that the blood supply is restored and the person feels normal again, with no permanent damage being done. Often the whole thing will be over in a matter of hours. But sometimes a TIA can lead to a full stroke within a day or two. Sometimes it is the precursor of a stroke in the months ahead, as it was with Andrew.
That's why I am supporting a new campaign from the Stroke Association which aims to raise awareness of the potentially catastrophic consequences of TIAs. A recent survey it carried out among 2,000 members of the public found very little awareness of TIAs, their symptoms and significance. A later survey of 670 people who had recently suffered a TIA revealed that more than half had never heard of a TIA or mini-stroke, and had no idea what was happening to them. According to the Stroke Association, 10,000 strokes a year could be avoided if all TIAs were treated urgently. That's 10,000 people who could be spared death or disability and 10,000 families who could be spared an immense trauma. We should consider the economic cost, too. Stroke is the third largest cause of death in the UK, and also the largest cause of disability. The cost to the economy, including direct costs to the NHS as well as informal care, benefits paid and lost productivity, is around £9bn, according to a report from the National Audit Office.
It's not just the public who don't know enough about TIAs. The same survey by the Stroke Association found that 16% of people didn't feel they were taken seriously when describing their symptoms and 25% reported that health professionals didn't realise that they had had a TIA. Stories of misdiagnosis range from patients being told they had a migraine, being referred for eye tests or believing they had sciatica.
The television presenter Chris Tarrant, who suffered a mini-stroke in March on a flight from Bangkok to London, initially thought he was suffering from asthma.
To be fair, TIAs are often hard to diagnose, because the symptoms can vary. The most obvious symptoms are the same as those for stroke: facial weakness, often resulting in a drooping mouth; arm or leg weakness, speech difficulty, blurred vision and dizziness. Yet not all of these happen all of the time. Andrew had no arm or leg weakness during his TIAs. Some of those surveyed declared they hadn't had any facial weakness, so didn't think they could be having a mini-stroke.
The benefits of quick diagnosis are immense. Clot-busting drugs can be given early to ensure that the blood clot dissolves before any brain damage occurs. Often tests will reveal high blood pressure or high cholesterol, in which case medication such as ACE inhibitors and statins can be prescribed, along with lifestyle changes – yes, more fruit and vegetables and more exercise. Atrial fibrillation is another condition, often undetected, which affects heart rhythm and increases the risk of clots. So even those who like to think of themselves as young and fit shouldn't rule out getting tests if they do suffer "a funny turn".
As with so many health conditions, there is a postcode lottery when it comes to TIAs. Some parts of the country now have specialised clinics for rapid diagnosis and staff in the ambulance service and in GP surgeries have received excellent training in how to spot the symptoms of a mini-stroke. But in other places you could well get sent home with a paracetamol. Follow-up care is also patchy. One patient reported that she only realised she had suffered a TIA when she read her medical notes – no one at the hospital had bothered to tell her, nor followed up her symptoms.
Southend University hospital is one that leads the way. Its TIA clinic used to open only five days a week and could only see three patients a day. But since 2012 the service has become a seven days a week operation – essential, since strokes and mini-strokes don't respect weekday working hours – and all high-risk patients are seen within 24 hours. A rapid referral system using the internet and mobile phones means that there is much less likelihood of a patient being left to have a full stroke while waiting to be seen. The key factor in making a good recovery from a stroke is speed: the sooner a patient is treated, the less likelihood there is of permanent damage. So the advice to those without a good TIA clinic nearby is to go straight to A&E.
What happens if you don't act fast? Well, 16 months on from his stroke, my husband is still left with a pretty useless left arm and has to wear an electronic device with an ankle brace to help him walk. He endures or enjoys (depending on whether you talk to Andrew or the physiotherapists) five hours of physiotherapy every week and performs endless repetitive exercises to try to recover better function in his left arm and leg. And he was one of the lucky ones: his cognitive skills and memory were not affected, as they often are with a stroke.
No one can spend their life saying "if only". You have to accept where you are and get on with it. But if only we had known a bit more about TIAs a couple of years ago, life would have been very different. If this new campaign from the Stroke Association can prevent any strokes at all, let alone 10,000 a year, then it will be very worthwhile.
A funny turn could otherwise turn out to be not very funny at all.