From the Guidelines
A Transient Ischemic Attack (TIA) is a temporary interruption of blood flow to part of the brain that causes stroke-like symptoms which resolve completely within 24 hours, though most typically last less than one hour. Often called a "mini-stroke," a TIA produces symptoms similar to a stroke including sudden weakness or numbness on one side of the body, slurred speech, vision changes, dizziness, or severe headache. Unlike a stroke, TIA symptoms disappear completely without causing permanent brain damage. However, a TIA is a serious warning sign that should never be ignored as it indicates a high risk for a future stroke, with a risk of subsequent stroke as high as 8.8% at 7 days and 11.6% at 90 days 1.
Key Characteristics of TIA
- Symptoms resolve completely within 24 hours
- Most symptoms last less than one hour
- No permanent brain damage
- High risk for future stroke
Importance of Immediate Medical Attention
Immediate medical attention is essential if TIA symptoms occur - call emergency services (911) immediately. Treatment typically includes antiplatelet medications like aspirin (usually 81-325mg daily), clopidogrel (75mg daily), or combination therapy depending on individual risk factors. Some patients may require anticoagulants like warfarin or direct oral anticoagulants if atrial fibrillation is present. TIAs occur when a blood clot temporarily blocks an artery supplying the brain, often due to atherosclerosis (plaque buildup in arteries), heart conditions, or blood clotting disorders. Risk factors include high blood pressure, smoking, diabetes, high cholesterol, obesity, and family history of stroke 1.
Diagnostic Considerations
The evaluation of patients with clinical carotid TIA or minor stroke requires rapid vascular imaging of the cervical carotid arteries in addition to brain parenchymal imaging 1. This is crucial for identifying the underlying cause of the TIA and guiding treatment decisions, such as carotid endarterectomy (CEA) or stenting.
Treatment and Prevention
The goal of treatment is to prevent a future stroke, and this is achieved through a combination of lifestyle modifications, medical therapy, and surgical interventions. Lifestyle modifications include quitting smoking, exercising regularly, and maintaining a healthy diet. Medical therapy includes antiplatelet medications, anticoagulants, and medications to control blood pressure, diabetes, and high cholesterol. Surgical interventions, such as CEA or stenting, may be necessary for patients with significant carotid stenosis. By prioritizing morbidity, mortality, and quality of life, healthcare providers can develop an effective treatment plan to reduce the risk of future stroke and improve outcomes for patients with TIA.
From the Research
Definition of Transient Ischemic Attack (TIA)
- A Transient Ischemic Attack (TIA) is an episode of reversible neurologic deficit caused by temporary focal central nervous system hypoperfusion 2.
- TIA is characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but is distinguished from ischemic stroke by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours 3.
Clinical Presentations and Diagnosis
- The manifestations of TIA are varied and include events that involve the anterior and posterior cerebral circulations 4.
- Correct diagnosis depends on an accurate medical history and physical examination, combined with the appropriate neuroimaging 4.
- It is uncommon that syndromes such as syncope, isolated dizziness, drop attacks, or global amnesia are caused by cerebral ischemia or TIA 4.
Risk and Management
- Patients with TIA have a high risk for stroke within the next 48 hours, making it a medical emergency 2.
- The short-term risk of ischemic stroke after TIA is very high, and rapid recovery from neurological symptoms may be indicative of reversal of ischemia and tissue still at risk 3.
- Rapid treatment following a TIA can minimize cerebrovascular damage and prevent recurrence, and addressing modifiable risk factors can reduce the risk of subsequent cardiovascular and cerebrovascular events 5.
- Public education about both the urgency and nature of TIA is required, as many patients delay seeking medical attention after a TIA irrespective of correct recognition of symptoms 6.