A stroke is often preceded by a "mini-stroke" the symptoms are similar but with a mini-stoke, they stop within 24 hours and usually within five minutes.
Still, it's crucial to see a doctor for what is formally called a transient ischemic attack (TIA) because it is a warning sign that a stroke could occur. About one-third of people with a TIA will have a stroke within a year.
But do you have to go to a hospital for evaluation? Not necessarily.
A 2011 study in the journal Neurology urged development of urgent-access TIA clinics, based on a finding that hospitalization is not cost-effective compared to same-day clinic evaluation.
Utah is one of the few places in the world with such a clinic, the Intermountain Stroke Center in Murray.
Neurologist and founder Nancy Futrell is promoting the center in an effort to shift her patient base from those with dementia, headaches and past strokes to include more TIA patients. She's able to care for them immediately as required because she has the needed equipment including a CT scanner and because it's cheaper than a hospital, she said. With health care reform, "there's sort of a call out to physicians to look for ways to provide the same care or better care for less money," she said.
During the TIA evaluation, doctors are searching for the cause of a blood clot. TIA patients need to have a CT scan to rule out any risk of bleeding. If patients are bleeding, Futrell gets them to the emergency department because they may need neurosurgery.
If they aren't bleeding, Futrell can treat them with medication. She can also do an ultrasound of the carotid arteries to determine if there is a blockage, and an electrocardiogram to check for atrial fibrillation.
"If this evaluation is done immediately, these patients can be evaluated as an outpatient and stay as outpatients," she said.
Within a week, she schedules patients for a CT coronary angiogram, an MRI to see if they've had mini-strokes in the past, a cardiac ultrasound and other tests.
She charges $2,000 for the work done at her office, which she says would cost up to four times more at a hospital.
And while more hospitals are improving treatment of patients having a stroke, "they're not trained in the TIA," said Futrell, a pioneer in the use of clot-busting drugs for strokes.
She said patients may not see a neurologist at the ER. And she's later seen patients who had a TIA but were misdiagnosed with a migraine, inner ear disease or depression.
Primary care doctors would have to order the necessary tests, which can take days. "We get patients treated within an hour of walking in our door," Futrell said.
Physician Chad Christensen said he regularly sends patients from the urgent-care clinic where he works to Futrell if their stroke-like symptoms have subsided because it's fast and less expensive.
"I don't have a CT scanner. I don't have the ability to do a complete evaluation," he said. "The ER can do it but the cost tends to be higher."
Still, if patients are having symptoms he recommends they go straight to the ER because it may be an actual stroke, and it isn't worth waiting to see if the symptoms go away.
"This is your brain. Of course we hope it's a TIA, but we're not going to wait around and see," he said.