What are Transient Ischemic Attacks (TIAs)?

From the Guidelines

A Transient Ischemic Attack (TIA) is a temporary period of stroke-like symptoms that typically lasts only a few minutes to hours without causing permanent brain damage. Often called a "mini-stroke," a TIA occurs when blood flow to part of the brain is briefly blocked, usually by a blood clot. Symptoms include sudden weakness or numbness on one side of the body, confusion, trouble speaking, dizziness, loss of balance, or vision problems. While TIAs don't cause permanent damage, they are serious warning signs that a full stroke may occur in the near future. According to the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack, an accurate diagnosis of ischemic stroke or TIA is essential for justifying and optimizing stroke prevention 1.

Importance of Accurate Diagnosis

About 15% to 25% of patients thought to have a nonstroke diagnosis for their neurological symptoms will be given the diagnosis of stroke with the help of brain imaging 1. This highlights the importance of brain imaging in the acute setting to exclude stroke mimics and to include stroke “chameleons” (stroke initially thought to be an alternative diagnosis).

Treatment and Prevention

Treatment typically includes antiplatelet medications, blood pressure control, cholesterol management, and lifestyle modifications such as smoking cessation, regular exercise, and a healthy diet. If you experience TIA symptoms, seek emergency medical care immediately, even if symptoms resolve. Prompt medical attention is crucial for preventing a more serious stroke. TIAs occur because of temporary blockages in blood vessels supplying the brain, often due to atherosclerosis (plaque buildup in arteries) or small clots from the heart.

Key Points to Consider

• TIAs are temporary periods of stroke-like symptoms without permanent brain damage
• Accurate diagnosis is essential for justifying and optimizing stroke prevention
• Brain imaging is crucial in the acute setting to exclude stroke mimics and include stroke “chameleons”
• Treatment includes antiplatelet medications, blood pressure control, cholesterol management, and lifestyle modifications
• Prompt medical attention is crucial for preventing a more serious stroke 1.

From the Research

Definition of TIAs

• Transient ischemic attack (TIA) is a cerebrovascular disease with temporary (<24 h) neurological symptoms 2
• TIAs are temporary focal cerebral or retinal deficits that resolve within 24 hours 3
• The definitions of TIA and stroke have evolved with advancements in medical imaging, with approximately one-third of events that last less than 24 hours being associated with new infarctions on modern imaging sequences 4

Symptoms of TIAs

• The symptoms of TIA patients are largely similar to those of ischemic stroke patients and include unilateral limb weakness, speech disturbances, sensory symptoms, visual disturbances, and gait difficulties 2
• Some symptoms, such as monocular blindness, are much more common in TIA than in stroke, and limb shaking occurs almost exclusively in TIA patients 2
• Symptoms like hemivisual field defects or limb ataxia are underappreciated in TIA patients 2

Risk of Stroke after TIA

• Approximately 10% of patients with TIA will have a stroke within 90 days without urgent evaluation and management 4
• The risk of stroke is greatest in the weeks following TIA 3
• The ABCD(2) and ABCD(3)-I scores are validated measures that can help predict which patients are at greatest risk of stroke after TIA 4

Management of TIAs

• Early attention should focus on risk factor modification, with emphasis on the treatment of hypertension and smoking cessation 3
• Antiplatelet therapy should be instituted, with aspirin being the first-line treatment 3
• Dual antiplatelet therapy with aspirin and clopidogrel may be useful in the first 30 days after TIA, but these drugs should not be used in combination after that time 4
• Carotid endarterectomy for symptomatic internal carotid artery high-grade stenosis virtually abolishes stroke risk in that vascular territory over subsequent years 3