Transient Ischemic Attack

Definition

Transient ischemic attack (TIA) is a brief problem of the brain. It is due to a shortage of blood and oxygen. TIA is sometimes called a mini-stroke.

TIA is a serious problem. It is a warning of a future stroke.

Blood Supply to the Brain

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Causes

TIA happens when blood flow to the brain is too low. This can be from a narrowing or a blockage. Narrowing may happen with:

• A build up of plaque, called atherosclerosis
• Vasculitis—inflammation of the blood vessels

A blockage may happen with:

• A piece of a blood clot or plaque that has broken off from another site
• Blood and blood-clotting problems, such as:
  • Severe anemia—too few red blood cells
  • Polycythemia—too many red blood cells
  • Hyperviscosity—thickening of the blood
• Endocarditis—an infection of the lining of the heart

Risk Factors

TIAs are more common in older adults. Some things that may raise the risk of TIA are:

• A history of TIAs
• Atrial fibrillation (AF) or other heart problems
• Smoking
• Metabolic syndrome
• Alcohol use disorder
• Diabetes
• High cholesterol
• Obesity

Symptoms

TIA symptoms happen quickly. The problems a person has depends on the part of the brain that is affected. Symptoms are like those of a stroke.

• Loss of strength
• Clumsiness
• Problems speaking
• Problems seeing, such as blindness in one eye
• Numbness or tingling
• A feeling of spinning when you are still

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Tests that may be done include:

• Blood tests
• MRI scan of the head
• MR angiography to assess blood vessels in the head using magnetic imaging
• CT scan of the head
• CT angiogram to assess blood vessels in the brain and neck with contrast dye
• Doppler ultrasound to assess blood flow in the arteries supplying the brain
• Electrocardiogram (EKG) to measure the heart's electrical activity

Treatment

The effects of TIA do not last. Most people recover in a few minutes. However, a TIA means there is an increased risk of a stroke. The risk is highest in the first week after a TIA. The goal of treatment is to lower the risk of a future stroke. Medical care is needed to make the best plan for prevention. Steps may include:

• Lifestyle changes, such as not smoking, eating a healthful diet, exercising, and limiting alcohol
• Medicines to prevent blood clots or to slow clotting
• Surgery to ease blockage in blood vessels
• Managing health problems, such as diabetes, high blood pressure, or high cholesterol

Prevention

TIA cannot always be prevented. To lower the risk:

• Manage high blood pressure.
• Avoid using tobacco.
• Limit alcohol.
• Maintain a healthy weight through diet and exercise.

Resources

American Heart Association
http://www.heart.org

National Stroke Association
http://www.stroke.org

Canadian Resources

Canadian Society for Vascular Surgery
http://canadianvascular.ca

Heart and Stroke Foundation
http://www.heartandstroke.com

References

Duca A, Jagoda A. Transient Ischemic Attacks: Advances in Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am. 2016 Nov;34(4):811-835.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/risk-factors-for-stroke-or-transient-ischemic-attack. Accessed October 5, 2020.

Sangha RS, Caprio FZ, et al. Quality of life in patients with TIA and minor ischemic strokes. Neurology. 2015;85(22):1957-1963.

Transient ischemic attack information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page. Accessed October 5, 2020.

Transient ischemic attack (TIA). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/transient-ischemic-attack-tia. Accessed October 5, 2020.

• EBSCO Medical Review Board Rimas Lukas, MD
• 202009
• 20210525