Transient ischemic attack

TIA, Transient Cerebral Ischemia, Intermittent Cerebral Ischemia, Impending Cerebrovascular Accident

What is transient ischemic attack?

Transient ischemic attack (TIA) refers to a temporary loss of blood flow to a part of the brain, usually due to blockage of the carotid or vertebral arteries in the neck. Symptoms associated with TIA are similar to those associated with a stroke, except that they disappear completely within twenty-four to forty-eight hours. TIAs are typically associated with high blood pressure (hypertension) and arteriosclerosis, a disease in which fatty deposits (plaque) build up along the interior walls of arteries. Plaque deposits may become large enough to temporarily block blood flow or may promote the formation of blood clots that occlude the artery in which it formed or dislodge to occlude an artery downstream.

Typically, alternative circulation routes are sufficient to overcome narrow, even blocked arteries. As these plaque deposits continue to build, these safety factors may become overwhelmed, indicating a potentially dangerous problem that requires medical treatment. TIA is an important warning sign that should be taken seriously because it may signal an imminent stroke or cerebral hemorrhage.

Health and lifestyle factors that place an individual at-risk for having a TIA or stroke include smoking, diabetes, heart disease, hypertension, and advanced age.

How is it diagnosed?

Symptoms of Transient Ischemic Attack

Symptoms typically include a loss of sensation or motor skills, vision disturbances, weakness, numbness, slurred speech, vertigo and problems with balance, incoordination, and an inability to speak or think clearly.

Individuals may also have elevated blood pressure. Individuals may report episodes that only last a few minutes, but occasionally, they may continue for several hours. Episodes may recur, the individual may later experience a stroke, or in some cases, the individual may experience no further symptoms.

If the carotid artery in the neck is involved, symptoms include weakness and numbness on one side of the body and possibly temporary blindness. Weakness in both arms or legs may suggest involvement of the vertebral artery. Confusion, vertigo, blindness, disequilibrium, weakness, and burning and prickling feelings in the extremities indicate that a TIA has occurred in the brain stem.

Physical exam: When diagnosing a TIA, the rapid onset of symptoms and the short duration of the episode are significant. Recurrent episodes of TIAs are common. Physical symptoms are similar to those of stroke, though they are typically of a milder nature.

Tests: To confirm vessel blockage or atherosclerosis, an individual may undergo diagnostic MRI and CT scans, or angiography. Doppler and ultrasound of the carotids may be performed. These procedures help to locate problem areas and aid in planning the course of treatment for the individual.

How is transient ischemic attack treated?

Because signs or symptoms are of short duration, individuals may ignore them. However, it is imperative that physicians are made aware of the condition and the symptoms are addressed.

Treatment of the underlying cause is necessary. Medications for hypertension, atherosclerosis, and thrombosis are typically prescribed to prevent a recurrence or progression of the condition. Aspirin therapy is often the drug of choice. If the carotid artery is involved, a carotid endarterectomy procedure may be necessary to remove blockage, or if blockage is severe, a vessel graft or resection may be required.

Medications

Information Brand Generic Label Rating
buy Clopidogrel Plavix Clopidogrel On-Label
Coumadin Warfarin

What might complicate it?

As symptoms are often mild, individuals may dismiss them. Contributing conditions include diabetes, smoking, obesity, heart disease, or a condition known as polycythemia in which the bone marrow produces too many blood cells.

Predicted outcome

TIAs are generally of short duration and symptoms generally disappear within 24 hours. TIAs should be taken very seriously as a predictor of impending stroke. Approximately one in three individuals who experience a TIA will have a stroke within five years, particularly if the underlying conditions are not addressed.

Alternatives

Differential diagnoses include seizure, brain tumor, migraine, and Meniere's disease.

Appropriate specialists

Neurologist, radiologist, cardiologist, cardiovascular surgeon and thoracic surgeon.

Seek Medical Attention

  • You or a family member has symptoms of a TIA.
  • Symptoms of a TIA recur after diagnosis and persist longer than 2 hours.

Last updated 22 December 2011


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