An Overview of Transient Ischemic Attack (TIA)

An illustration showing the cause of a TIA.
An illustration showing the cause of a TIA. BSIP/UIG/Getty Images

A transient ischemic attack (TIA), also called a mini-stroke, is a temporary loss of normal neurological function, caused by a transient interruption of blood flow to part of the brain.

The symptoms of a TIA require immediate medical attention and are the same as those of a stroke. They may include weakness or numbness in the face, hand, arm, or leg, vision changes, and/or slurred speech, to name a few.

Diagnosis of a TIA requires a careful medical history and neurological exam, as well as imaging of the brain and the large blood vessels that supply the brain. Heart testing and various blood tests may also be ordered.

When treating a TIA, it's important to aggressively treat underlying risk factors like high blood pressure and high cholesterol.

Additional TIA therapies include taking medication to prevent new blood clots from forming and sometimes, restoring blood flow to the carotid artery through a process called revascularization.

Symptoms 

The precise symptoms of a TIA vary tremendously from person to person and depend on which part and how much of the brain is being deprived of blood flow.

That said, some of the typical symptoms of TIA include:

  • Weakness in the hand, arm, leg, face, tongue, or face
  • Numbness in the hand, arm, leg, face, tongue, or face
  • Inability to speak coherently
  • Unexplained dizziness, often with vertigo (the sensation that the room is spinning)
  • Double vision, partial loss of vision, or other sudden visual disturbances
  • Severe headache with no apparent cause

Distinguishing TIA From Stroke

The symptoms of a TIA are identical to the symptoms of a stroke, except that TIA symptoms go away within minutes to hours before any permanent brain damage can occur.

This is because, in a TIA, blood flow is restored before brain tissue actually dies. With a stroke, on the other hand, blood flow to a region of the brain is interrupted long enough for brain tissue damage to occur.

A TIA is distinguishable from a stroke only when the symptoms resolve by themselves. Until that moment, for all practical purposes, you are having a stroke.

Anyone who has had a TIA has a high risk of having a completed stroke in the near future. In fact, according to a study of 4700 patients with TIA, the estimated risk of stroke one year later was 5%.

Causes and Risk Factors

TIAs are caused by the same disease processes that produce stroke—blockage of the arteries to the brain from a blood clot, mostly due to atherosclerosis (fatty buildup in an artery) or embolism (when a blood clot travels from somewhere else in the body, like the heart, to the brain)

The only difference is that in stroke, the blockage persists long enough to produce the death of brain tissue. With a TIA, the blockage is transient, and the brain tissue recovers once the blockage improves.

TIAs are therefore analogous to unstable angina, a condition in which transient blockages in the coronary arteries produce chest pain. And just as unstable angina often heralds a full myocardial infarction, the occurrence of a TIA indicates that a full stroke is likely to occur.

There are several factors that increase a person's risk for developing a TIA (and a stroke). 

Some of these factors include:

Diagnosis

The diagnosis of TIA requires a careful medical history and physical examination, as well as imaging and blood tests.

Medical History

A good medical history is vital to diagnosing a TIA; although, other tests are needed to confirm the diagnosis.

During the medical history, a doctor will want to ask questions regarding the specifics of a patient's symptoms, like whether the symptoms are focal (weakness or numbness on one side of the body) or nonfocal (e.g., generalized weakness or light-headedness), whether the symptoms came on suddenly or gradually, or if the symptoms have occurred before.

Questions like these can help sort out whether alternative health conditions need to be considered in more depth, like migraine, multiple sclerosis, or a seizure disorder.

Physical Examination

To diagnose a TIA, the physical examination will include a measurement of the vital signs (e.g., systolic and diastolic blood pressure), a heart exam, and a complete neurological exam (e.g., checking reflexes and a cranial nerve exam).

Imaging

If your doctor thinks you have had a TIA, various imaging tests will be performed, which are aimed at identifying the precise cause of the event. Brain imaging is also used to rule out conditions that may mimic a TIA.

Here are the imaging tests ordered during the workup of a TIA:

Blood Tests

Blood tests are utilized to not only rule out conditions that mimic TIA but to also access a person's risk for developing a recurrent TIA or stroke.

Examples of such tests include:

Treatment

Once an evaluation for a TIA is complete, the treatment your doctor recommends will depend largely on what has been found.

The main goal of treating a person who has had a TIA is to prevent a stroke.

Treatment very often includes:

Treating Underlying Risk Factors

Aggressively treating the risk factors that produce atherosclerosis, such as hypertension and high cholesterol, getting excellent control of diabetes, adopting a healthy diet, exercising regularly, and encouraging (demanding, if possible) smoking cessation, can prevent the re-occurrence of a TIA or more seriously, a future stroke.

Antiplatelet Therapy

Antiplatelet therapy, with aspirin, aspirin plus dipyridamole, or Plavix (clopidogrel), is used to inhibit the formation of abnormal clots within the arteries.

Anticoagulant Therapy

Anticoagulation therapy with Coumadin (warfarin) is used to treat certain health conditions, such as atrial fibrillation, that promote blood clot formation.

Carotid Artery Revascularization

If a significant blockage in a carotid artery (located in your neck) is found, your doctor may recommend "carotid endarterectomy" (surgical opening and repair of the carotid artery). Stenting of the carotid artery (propping the artery open to improve blood flow), is another option, depending on certain patient characteristics.

A Word From Verywell

Even though the symptoms resolve on their own, a TIA is a very serious medical problem. By seeking immediate medical care after a TIA, you can greatly reduce your odds of having a full stroke.

If you have been treated for a TIA or stroke, focus your energy on preventing the next one, which you have the power to do—by taking your prescribed medications, eating healthily, exercising regularly, and eliminating bad habits like smoking or excessive alcohol intake.

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