From the Guidelines
A Transient Ischemic Attack (TIA) is a temporary episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without evidence of acute infarction, typically resolving within 24 hours, though most TIAs last less than one hour. Management of TIA requires urgent evaluation, ideally within 24-48 hours, as it represents a medical emergency and warning sign for potential future stroke. Initial management includes hospital admission or rapid outpatient evaluation with brain imaging (CT or MRI), vascular imaging (carotid ultrasound, CTA, or MRA), and cardiac assessment (ECG, echocardiogram) 1.
Key Components of TIA Management
- Antiplatelet therapy should be started immediately, typically with aspirin 325mg initially, followed by daily aspirin 81-325mg, or clopidogrel 75mg daily 1.
- For patients with atrial fibrillation, anticoagulation with warfarin (target INR 2-3) or direct oral anticoagulants like apixaban, rivaroxaban, or dabigatran is indicated 1.
- Controlling vascular risk factors such as hypertension (target <130/80 mmHg), diabetes (target HbA1c <7%), and hyperlipidemia (high-intensity statin therapy regardless of baseline LDL) is crucial 1.
- Carotid revascularization should be considered for patients with significant carotid stenosis (>70%) 1.
- Lifestyle modifications including smoking cessation, regular physical activity, limited alcohol consumption, and a Mediterranean or DASH diet are essential components of secondary prevention 1. TIAs require urgent attention because they indicate unstable cerebrovascular conditions that can progress to completed strokes, with the highest risk occurring within the first 48 hours after the event 1.
From the Research
Definition of Transient Ischemic Attack (TIA)
- A Transient Ischemic Attack (TIA) is a transient episode of neurologic dysfunction caused by loss of blood flow to the brain or spinal cord without acute infarction 2.
- TIA is a brief episode of reversible neurological deficits caused by focal and temporary central nervous system ischemia 3.
- It is an episode of reversible neurologic deficit caused by temporary focal central nervous system hypoperfusion 4.
- The definition of TIA has changed from a focal, neurologic event that lasts less than 24 hours to one that typically lasts less than 1 hour and is not associated with changes on neuroimaging 5.
Symptoms of TIA
- 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 6.
- Some symptoms, such as monocular blindness, are much more common in TIA than in stroke, and limb shaking occurs almost exclusively in TIA patients 6.
- Symptoms like hemivisual field defects or limb ataxia are underappreciated in TIA patients 6.
Management of TIA
- The treatment following acute recovery from a TIA depends on the underlying cause 2.
- Patients who have more than 70% stenosis of the carotid artery, removal of atherosclerotic plaque is usually done by carotid endarterectomy surgery 2.
- Immediate evaluation and intervention for TIA lowers the risk of recurrent ischemic stroke 3.
- Educating the patients and inculcating lifestyle modifications in them are initial steps to minimize the prevalence of transient ischemic attack 2.
Diagnosis of TIA
- TIA is usually diagnosed after taking a thorough history and a physical examination 2.
- Several radiological tests such as computed tomography and magnetic resonance imaging are useful in the evaluation of patients who have had a TIA 2.
- Ultrasound of the neck and an echocardiogram of the heart are other tests useful in the diagnosis and evaluation of the attack 2.
- High ABCD2 score, carotid artery stenosis, and DWI lesions suggest that patients are at a high risk for early recurrence of ischemic stroke 3.