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

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.

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.