Typical Sequence of Symptoms

1. A sudden but small decline in mental faculties or slight weakness of an arm or leg.

2. Confusion and memory lapses that last a few days.

3. Gradual but incomplete recovery in mental faculties.

This sequence occurs because the brain reacts to the ministroke by pouring out edema fluid that compresses the area surrounding the dying brain tissue. As the edema subsides, the nerve cells that were compressed and paralyzed by the edema fluid regain their function, but those cells that already died in the center of the ministroke (infarct) cannot recover. Hence, there is only partial clinical recovery after each ministroke. If these little strokes occur repeatedly over several years, they can lead to full-blown dementia with severe memory loss. The history of repeated, staggered decline with incomplete cognitive recovery between episodes, together with clinical plus CT or MRI evidence of multiple strokes, help make the diagnosis.

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