Transient Ischemic Attack (TIA)

What is a transient ischemic attack (TIA)?

A transient ischemic attack (TIA) is often referred to a ‘mini stroke’. However, they are just as serious as a stroke[KP1] as there is a temporary lack of blood flow to a part of the brain. When blood flow is interrupted, the brain cells begin to malfunction and die.

A TIA is a serious medical emergency, just like a stroke. Like an ischemic stroke, the symptoms are similar, but in TIA, the symptoms resolve within 24 hours (usually within minutes).

As there is no way to predict how long a TIA will last, seek emergency help immediately as every minute counts. Don’t wait to see if the symptoms improve. Symptoms of stroke include balance problems, vision changes, drooping of the face, arm weakness, and speech difficulties.

What are the differences between TIA and mini-stroke?

TIAs are often called mini strokes, but this is not accurate, and they aren’t necessarily mini or smaller. A TIA can affect large areas of the brain, and a stroke can happen after a TIA (this may be within minutes, hours or days).

The two important differences between TIA and stroke are:

• A TIA will stop on its own, but a stroke won’t and needs treatment to stop it and reverse the effects.
• A stroke leaves visible changes on an MRI scan which stay, even once the symptoms have gone.

What are the symptoms of transient ischemic attacks?

The symptoms of TIA and stroke are similar. TIA symptoms include acute onset of one or more of the following:

• Loss of vision, or blurred/double vision
• Confusion
• Difficulty with speech
• Dizziness or vertigo
• Headaches
• Loss of coordination
• Loss of facial muscle control/drooping on one side
• Memory loss
• Nausea and vomiting
• Neck stiffness
• One-sided weakness
• Passing out or fainting
• Slurred speech
• Sudden loss of the senses (one or more)

What causes transient ischemic attacks?

TIAs and ischemic strokes are both caused by the following:

• A clot forming in your brain (called thrombosis)
• A fragment of a clot, from elsewhere in your body, breaking free and traveling to the brain where it gets stuck (called thromboembolism)
• A blockage in a small vessel (called lacunar stroke)
• Unknown causes (called cryptogenic TIA)

What are the risk factors for transient ischemic attacks?

There are many things that can contribute to a TIA or increase the risk of one happening. These include:

• High blood pressure (hypertension – the most significant risk factor)
• Type 2 diabetes
• Smoking and tobacco use
• Atrial fibrillation (Afib)
• Personal history of TIA or stroke
• Heart disease
• Previous heart attack
• High cholesterol
• Obesity
• Age
• Obstructive sleep apnea

How is a transient ischemic attack diagnosed?

TIAs are diagnosed via the following methods:

• Asking about your medical history and symptoms
• Physical and neurological examination
• Imaging scans: A CT scan can quickly show a bleed on the brain. An MRI scan can show whether you had a TIA or stroke.

How is a transient ischemic attack treated?

A TIA is a temporary problem, but it can indicate that a stroke may happen (which is not temporary and is a much more serious condition). Therefore, treating the condition or conditions that caused the TIA can prevent a stroke.

TIA treatment is often aggressive, to ensure a stroke doesn’t happen. Strokes are harder to treat and often cause permanent damage or death, even with treatment.

Treatments after a TIA, to prevent stroke, include:

Medications

Medications are given to treat the conditions that have caused a TIA, or to prevent stroke or TIA from happening in the future. Medications include:

• Aspirin: Reduces the risk of blood clots that can lead to stroke.
• Blood pressure medication: Reduces the pressure inside blood vessels (includes angiotensin II receptor blockers (ARBs), calcium channel blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors and more).
• Statins: These lower the level of a cholesterol called low-density lipoprotein (LDL) cholesterol. LDL can build up in blood vessels, causing them to narrow and lead to atherosclerosis.
• Blood thinners: These make it harder for the blood to clot, lowering the risk of clots forming and becoming stuck in a blood vessel in the brain.

Catheter-based procedures

These are procedures that use thin tubes which are inserted into the blood vessels through small incisions in the skin, without the need for surgery. They usually involve the carotid arteries, which are the main vessels carrying blood from the heart to the brain. A narrowing in these arteries can lead to a stroke or TIA. Procedures which can treat ischemic stroke or TIA include:

• Angioplasty: A catheter is inserted which has a balloon attached. The balloon is inflated inside the narrowed artery to widen it and allow blood flow.
• Endovascular thrombectomy: Performed to remove a blood clot, the artery is opened and blood flow to the brain is restored.
• Stenting: A small mesh called a stent is placed inside a blood vessel to hold it open so blood can flow through it.

Endarterectomy

If catheter-based procedures are not possible, then surgery may be recommended. Surgery aims to widen blood vessels to prevent another TIA or stroke. A carotid endarterectomy is a surgery during which plaque inside the carotid blood vessel in the neck is removed so a wider space for blood flow to the brain is created.

Remember, a transient ischemic attack (TIA) greatly increases your risk of having a stroke. A TIA may happen suddenly and disappear within minutes, but never ignore the symptoms. Always seek emergency medical help, as it may help you to avoid a life-threatening stroke in the future.