Transient Ischemic Attack (TIA)

TIA means:

T	Take
I	Immediate
A	Action

A transient ischemic attack (TIA) is sometimes termed a minor stroke or “mini” stroke. When the signs of stroke are present but go away within 24 hours, the term TIA or mini stroke is used. TIA episodes generally disappear quickly and unfortunately, are often ignored.

About 1 in 5 people who have a TIA will have a major stroke within the next three months and a large part of the risk occurs in the first few days. In fact:

• 5% of people will have a stroke within two days of their TIA
• 11 % of people will have a stroke within 90 days of their TIA
• 14 % of people will have a stroke within one year of their TIA
• 20 % of people will have a stroke within 2 years of their TIA.

Therefore, TIA or mini stroke should never be ignored. It should be regarded as a warning sign that the person is at risk of a stroke and should be investigated promptly.

Symptoms of Transcient Ischemic Attack (TIA)

Symptoms develop suddenly, and usually peak in less than a minute. The duration of symptoms varies, but symptoms usually go within an hour (typically within 2-15 minutes). Sometimes symptoms last up to 24 hours. The symptoms that develop depend on the part of the brain that is affected. Symptoms of TIA are the same as those that occur in stroke and include the sudden development of:

• numbness and tingling
• weakness, heavy feeling of extremities
• speech difficulty (garbled speech or slurred speech)
• decreased, double or loss of vision,
• loss of balance
• lack of coordination
• gait changes, staggering
• falling (caused by weakness in the legs).

Additional symptoms that may be associated with this disease:

• facial paralysis
• eye pain
• confusion.

Causes of Transcient Ischemic Attack (TIA)

TIA or mini stroke is caused by an interruption of blood flow to brain cells. A brief interruption to the blood flow can cause a decrease in brain function. The loss of blood circulation to the brain can be caused by the following:

• Low blood flow at a narrow part of a major artery carrying blood to the brain, such as the carotid artery
• A blood clot in another part of the body (such as the heart) breaks off, travels to the brain, and blocks a blood vessel in the brain
• Narrowing of the smaller blood vessel in the brain, blocking blood flow for a short period of time; usually caused by plaque build up that occurs during atherosclerosis.

Less common causes of TIA or mini stroke include blood disorders, spasm of the small arteries in the brain, abnormalities of blood vessels caused by various disorders, inflammation of the arteries, and syphilis. Other risks for TIA include high blood pressure, heart disease, migraine headaches, smoking, diabetes mellitus, and increasing age.

Diagnosis of Transcient Ischemic Attack

Medical history of specific symptoms and neurological examination provide the most important information required to diagnose a TIA or mini stroke. The main aim of the tests is to find if there is any problem that may increase your risk of blood clots forming, and to check for other uncommon causes of TIA. Tests that are commonly done include:

• Physical examination, including blood pressure measurement

• Blood tests – blood pressure test, blood clotting test, cholesterol test
• Electrocardiogram (ECG) tests to check for abnormal heart rhythms
• Chest x-ray
• Computerised tomography scan of the head
• Ultrasound scan of the carotid arteries
• Heart ultrasound to check for heart disease.

Management of Transcient Ischemic Attack

The goal of TIA management is to prevent a future stroke. The medicine and therapy used depends on the exact cause of the TIA. The lifestyle adjustments- such as eating healthy foods and quitting smoking may reduce your risk of further TIA or stroke. A reduced amount of sodium in the diet to help control high blood pressure; diet for diabetics; reduced dietary fat, or other dietary changes may be recommended.

Treatment of symptoms of blood disorders may include phlebotomy, hydration, and treatment of the underlying blood disorder. Antihypertensive medications may be used to control high blood pressure. Medications to lower cholesterol may be useful in reducing high blood cholesterol levels.

Platelet inhibitors and anticoagulant medications may be used to reduce clotting. Aspirin is the most commonly used medication; others include dipyridamole, clopidogrel, Aggrenox or heparin, coumadin, or other similar medications. Treatment may be continued for an indefinite time period.

Surgery (carotid endarterectomy - removal of atherosclerotic plaque from the carotid arteries in the neck) may be appropriate for some people, particularly those with carotid artery stenosis of greater than 70% of the artery and without coexisting terminal disease or dementia.