Transient ischaemic attack (TIA)
What is a transient ischaemic attack?
A transient ischemic attack (TIA) is a temporary neurological episode. It is also known as a 'mini-stroke'. It is caused by a temporary blockage or narrowing in a blood vessel leading to the brain. A person experiencing TIA will have signs and symptoms like those of a stroke, but will recover completely within minutes or a few hours.
TIA's main significance is as a warning sign: TIAs occur when the blood vessels feeding the brain are not in good condition. A person who has had a TIA is at serious risk of stroke, often within days of the TIA.
X
Neurological
Of the nervous system, including the brain.
Signs and symptoms
The signs and symptoms of a TIA are like those of a stroke. The difference between TIA and stroke is that in a TIA signs and symptoms are completely resolved, usually within a few minutes, while a stroke's effects are permanent. Thus, it is impossible - and inadvisable - to try and tell a TIA from a stroke while it is occurring.
Early warning signs - FAST
The FAST test is a set of early warning signs for stroke that anyone can use to recognize stroke. FAST is an acronym used to remember these points:
- Face - is the person's face droopy, flaccid, especially just on one side? Can they smile?
- Arms - can the person lift both their arms above their head?
- Speech - is the person having problems speaking and/or understanding speech? Is speech slurred?
- Time - the quicker you act, the better the chance of survival and recovery. Call 911, even if the symptoms go away.
The FAST test is used to diagnose early warning signs of a stroke.
Additional TIA signs and symptoms
Symptoms of a TIA include:
- Sudden paralysis of one side of the body (hemiplegia);
- Sudden weakness on one side of the body (hemiparesis), inability to move or lift the arm;
- Movement and coordination problems, especially if on one side only;
- Confusion, difficulty with speech or understanding speech, formulating thoughts, memory loss;
- Sudden, severe headache;
- Dizziness, vertigo;
- Nausea, vomiting, and;
- Blurred vision, loss of vision, or seeing only half the regular vision field (hemianopia), or a sudden blindness in one eye (amaurosis fugax). [1]
TIA and migraine
The early signs of a stroke can sometimes be similar to those of migraine. An authoritative diagnosis can only be made with a brain scan. For people who suffer from migraines, it is important to notice irregularities in their migraine symptoms and be alert to the possibility of stroke. An attack that is much more sudden than usual, and/or has different visual symptoms, might not be a migraine attack, but an early sign of stroke.
X
Nausea
A sensation of sickness and unease, typically felt in the stomach, often accompanied by the urge to vomit. Nausea is a common symptom with many possible causes.
X
Paralysis
An inability to move or feel; a loss of muscle function or sensation.
X
Murtagh, J. (2008). John Murtagh’s Patient Education (Australian edition.). North Ryde, N.S.W.: McGraw-Hill Book Company Australia.
Causes and types
A TIA is caused by a temporary blockage or narrowing in a blood vessel leading to the brain. Loss of blood supply to an area of the brain will cause a temporary problem within that area. In a TIA, the blood clot normally dissolves after a few minutes, and normal blood flow to the brain area is resumed.
A TIA can be the result of:
- A blood clot that forms in one of the brain's arteries;
- A blood clot that arrives at the artery from elsewhere in the body;
- A narrowing in a brain artery that reduces the blood flow within it, or;
- Minor damage to an artery that causes some bleeding before the blood vessel self-repairs.
A transient ischaemic attack is normally caused by a temporary blockage of a brain artery.
X
Arteries
A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.
X
Clot
The thickened or solid mass formed from a liquid, such as blood. Blood clots normally form at an injury site to prevent further blood loss.
Risk factors
Risk factors for TIA are similar to those of stroke, and include:
- High blood pressure;
- Age - anyone can have a TIA, but the risk increases in older adults;
- Smoking;
- A poor diet, obesity, high cholesterol;
- Diabetes;
- A sedentary lifestyle;
- Stress and depression;
- A family history of stroke;
- Ethnicity - the chance of stroke is higher in some populations;
- Excessive alcohol consumption;
- Heart disease, such as atrial fibrillation, and;
- A recent TIA or a previous stroke.
X
Blood pressure
The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.
X
Heart disease
A class of diseases that involves the dysfunction of the heart and/or the blood vessels.
X
Cholesterol
A type of fat produced by the body that is necessary for metabolism.
X
Diabetes
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
X
Stress
The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.
Methods for diagnosis
Since a TIA is sudden and is over quickly, diagnosis of a TIA typically happens after it has passed. Your doctor will ask you about your medical history and status, and about the symptoms you have experienced. Your doctor may then have you undergo a brain scan (a CT scan or an MRI) to understand why the TIA occurred and check for the risk of a future stroke. Blood tests can also help with diagnosis.
Your heart activity may also be examined and monitored, as stroke events can be closely related to heartbeat abnormalities.
X
Blood tests
During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analyzed to help diagnose and monitor a wide range of health conditions.
X
MRI
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
Types of treatment
TIA in itself is not treated, as it is a temporary event and leaves no lasting damage. After a TIA, the focus will be on monitoring you for signs of a stroke and preventing a stroke from occurring. This may include medication (for example, drugs to lower blood pressure) and lifestyle change (such as quitting smoking). Surgery is also an option in some cases.
The specific treatment after a TIA depends on underlying risk factors.
X
Blood pressure
The pressure the blood places on the walls of the arteries, largely mirroring the contraction of the heart, and consisting of two readings. The higher reading is systolic blood pressure, when the heart contracts, and the lower is diastolic blood pressure, when the heart is relaxed.
Prognosis
A TIA in itself is thought to leave no lasting damage, and its main significance is as a warning sign. However, some recent research suggests that TIAs can cause minor brain injury. [2] These may not affect the person in a noticeable way, but if TIAs recur, they may have a cumulative effect on brain health.
X
Edwards, J.D., Meehan, S.K., Levy, A.R., et al. (2011). Changes in Intracortical Excitability After Transient Ischemic Attack Are Associated With ABCD2 Score. Stroke 42: 728–733.
Prevention
You can lower your chances of a TIA (or the chances of further TIAs and a stroke) by adopting a healthier lifestyle; by limiting your alcohol consumption, quitting smoking, exercising and eating healthier food.
References
- Murtagh, J. (2008). John Murtagh’s Patient Education (Australian edition.). North Ryde, N.S.W.: McGraw-Hill Book Company Australia.
- Edwards, J.D., Meehan, S.K., Levy, A.R., et al. (2011). Changes in Intracortical Excitability After Transient Ischemic Attack Are Associated With ABCD2 Score. Stroke 42: 728–733.
- (Victoria) Department of Health. Stroke. Accessed 5 August 2014 from link here
- Edwards J.D. Meehan S.K. Levy A.R. et al. (2011). Changes in Intracortical Excitability After Transient Ischemic Attack Are Associated With ABCD2 Score. Stroke 42: 728–733.
- Van der Worp H.B. & van Gijn J. (2007). Acute Ischemic Stroke. New England Journal of Medicine 357: 572–579.
- Broderick J.P. Palesch Y.Y. Demchuk A.M. et al. (2013). Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke. New England Journal of Medicine 368: 893–903.
- Ciccone A. Valvassori L. Nichelatti M. et al. (2013). Endovascular Treatment for Acute Ischemic Stroke. New England Journal of Medicine 368: 904–913.
- Ding D. (2014). Intravenous Versus Intra-arterial Thrombolysis for Acute Ischemic Stroke Secondary to Basilar Artery Occlusion. Journal of Cerebrovascular and Endovascular Neurosurgery 16: 39–41.
- Donnan G.A. Fisher M. Macleod M. et al. (2008). Stroke. The Lancet 371: 1612–1623.
- Gibson C.L. (2013). Cerebral ischemic stroke: is gender important? Journal of Cerebral Blood Flow & Metabolism 33: 1355–1361.
- Grip O. Kuoppala M. Acosta S. et al. (2014). Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. British Journal of Surgery 101: 1105–1112.
- O’Donnell M.J. Xavier D. Liu L. et al. (2010). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. The Lancet 376: 112–123.
- Stroke. Better Health Channel. Accessed 5 August 2014 from link here
- Stroke Information | cdc.gov. Accessed 5 August 2014 from link here
- Stroke Information Page: National Institute of Neurological Disorders and Stroke (NINDS). Accessed 5 August 2014 from link here
- Stroke symptoms and diagnosis. Accessed 5 August 2014 from link here
- Transient ischemic attack. Accessed 5 August 2014 from link here
- Van der Worp H.B. & van Gijn J. (2007). Acute Ischemic Stroke. New England Journal of Medicine 357: 572–579.
- What Is a Stroke? - NHLBI NIH. Accessed 5 August 2014 from link here
- WHO | Stroke Cerebrovascular accident. WHO. Accessed 5 August 2014 from link here
9 Most frequently asked questions (FAQs)
What is the 'FAST' test for stroke? The FAST test is a set of early warning signs for stroke that anyone can use to recognize a stroke. FAST is an acronym for: Face (is it droopy, flaccid, especially just on one side? Can the person smile?); Arms (can the person lift both their arms above their head?); Speech (are there problems speaking and/or understanding speech? Is speech slurred?), and; Time (quick action will improve the chances of survival and recovery). What are the symptoms of a transient ischemic attack? The signs and symptoms of a TIA are like those of a stroke. They can include: sudden weakness on one side of the body (hemiparesis); inability to move or lift the arm; sudden paralysis of one side of the body (hemiplegia); movement and coordination problems; cognitive problems such as confusion, difficulty with speech, understanding speech, formulating thoughts and memory loss; blurred vision, loss of vision, or seeing only half the regular vision field (hemianopia), or sudden blindness in one eye. The difference between a TIA and a stroke is that a TIA usually passes within minutes, causing little lasting damage, while a stroke's effects are permanent. Thus, it is neither possible nor advisable to try to tell a TIA from a stroke while it is occurring. Who gets a transient ischemic attack? While anyone can have a TIA, it is more common in older adults. High blood pressure, smoking, a poor diet and obesity are also major contributors to the risk of a TIA. How is a transient ischemic attack diagnosed? Since a TIA is sudden and is over quickly, diagnosis of a TIA typically happens after it has passed. Your doctor will ask you about your medical history and status, and about the symptoms you have experienced. Your doctor may then have you undergo a brain scan (a CT scan or an MRI) to understand why the TIA occurred and to check for the risk of a future stroke. Blood tests can also help with diagnosis. How is a transient ischemic attack treated? TIA in itself is not treated, as it is a temporary event and leaves no lasting damage. After a TIA, the focus will be on monitoring you for signs of a stroke and preventing a stroke from occurring. This may include medication (for example, drugs to lower blood pressure) and lifestyle change (such as quitting smoking). Surgery is also an option in some cases. Can a transient ischemic attack be prevented? The risk of a TIA cannot be completely eliminated, but you can lessen the chance of it happening by stopping smoking, reducing high blood pressure, becoming more physically active and improving your diet.
Related topics
There are two main types of stroke: ischaemic stroke and haemorrhagic stroke. Haemorrhagic strokes account for about 20% of all stroke cases. A haemorrhagic stroke occurs when a blood vessel in the brain suddenly bleeds. As a result, blood collects in the brain, which causes an increase in pressure inside the skull that damages brain tissue. In addition, contact with blood causes inflammation in b There are two main types of stroke: ischaemic stroke and haemorrhagic stroke. Ischaemic strokes account for about 80% of all stroke cases. An ischaemic stroke occurs when an artery supplying oxygen-rich blood into the brain is blocked and oxygen cannot reach the brain tissue. This page details the types of ischaemic stroke and the treatment given. For more information on stroke signs and symptoms, A stroke happens when oxygen-rich blood cannot reach the brain cells, often due to blockage or damage of a blood vessel. This loss of oxygen damages brain cells within minutes, which then start dying. Occurring mostly in older adults, a stroke is a serious medical emergency. Vision loss, sometimes called vision impairment, can occur for many reasons. In some cases, it can be as simple as needing glasses or contact lenses, but in other cases it can be serious and irreversible.