Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Supporting Patients Through Small Strokes

"While Ms. R's body seemed to work fine, her mind just didn’t cooperate. She felt like she was in a fog sitting at her desk staring at the computer screen."


Cognitive dysfunction is common after small strokes. Reassure your patient that symptoms will improve over time and that recovery may take several months.

She was only 55. But Ms. R had high blood pressure, high cholesterol, diabetes, and a long family history of vascular risk factors. It wasn’t surprising when she suddenly developed weakness of her left face and arm while sitting at her desk at work. She was rushed to the hospital and diagnosed with a small stroke.


Feeling foggy

Her physical symptoms rapidly started to recover. By the end of the week her smile was almost normal and her hand was beginning to move. Over the next few weeks her symptoms continued to improve and within the month she felt ready to return to work and normal life. But while her body seemed to work fine, her mind just didn’t cooperate. She felt like she was in a fog sitting at her desk staring at the computer screen. She was so easily distracted it was hard to follow conversations when coworkers asked for help. By the end of the day she was exhausted. “What’s happening to me?” she thought.


Difficulty with attention, concentration, and multitasking

Our recent study published in PNAS indicated a blockage that prohibited the efficient flow of information within the cognitive network. A small stroke may not result in lasting aphasia or hemiparesis that’s immediately visible. However, that doesn’t mean patients don’t experience significant disability. In fact, many report difficulty with attention, concentration, and multitasking that impacts their ability to successfully return to work or reintegrate into society. It’s not entirely clear how a small lesion results in such global dysfunction and understanding the pathophysiology is needed before we can design effective treatments.


Cognitive symptoms of minor strokes

The cognitive impairment resulting from minor stroke is different than the typical memory problems reported with dementia. Instead, patients report feeling “fuzzy” and slow. They can complete tasks and give correct answers, it’s just a step behind everyone else. This can have a huge impact when attempting to contribute in a board meeting or manage a busy family. It’s especially important for healthcare professionals to recognize this, as these deficits cause patients to struggle when they attempt to go back to their normal lives. This can be hard to understand because patients otherwise appear to be doing well. The good news is that over the first six months patients often improve. But patients need proper counseling and management so that they can postpone making lasting life decisions, like moving in with family or taking early retirement.


Here are 5 things you can tell your patient who’s had a small stroke: 

1. Cognitive dysfunction is common after small strokes even though you may feel ok physically.

2. Post-stroke cognitive impairment isn’t like typical dementia. You may feel “fuzzy,” slow, and tired rather than confused and forgetful.

3. Symptoms get better over time, but it may take several months for you to feel like yourself again.

4. It’s probably best to postpone major life decisions for at least six months, or until you see significant improvement in symptoms.

5. Though it’s frustrating, the best thing to do is to keep your brain active. Identify what you’re struggling with and work on it until you see improvement.


This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.