Care New England Health Systems
Butler Hospital: (401) 455-6200
CNE Wellness Center: (401) 732-3066
Kent Hospital: (401) 737-7000
VNA of Care New England: (401) 737-6050
Women & Infants Hospital: (401) 274-1100

Transient Ischemic Attack

(TIA; Mini-Stroke)

Definition

Transient ischemic attack (TIA) is a temporary dysfunction of the brain due to a shortage of blood and oxygen. A TIA lasts no longer than 24 hours. It is sometimes referred to as a mini-stroke.
TIA is a serious condition. It serves as a warning for a potential stroke.
Blood Supply to the Brain
IMAGE
Copyright © Nucleus Medical Media, Inc.

Causes

Blood and oxygen are carried to the brain through major blood vessels in the neck. The blood then passes through a series of blood vessels in the brain. A TIA occurs when the blood flow through the neck or brain vessels is reduced. The blood flow may be reduced by a narrowing or blockage of the blood vessels.
Narrowing of the blood vessels may occur with:
  • Build up of plaque in the blood vessels, called atherosclerosis
  • Vasculitis—inflammation of the blood vessels
Blood vessels can also become blocked or obstructed by a clot or clump that is floating in the blood. This may be caused by:
  • A piece of blood clot or plaque that has broken off of another location
  • Blood and blood-clotting disorders such as:
    • Severe anemia—too few red blood cells
    • Polycythemia—too many red blood cells
    • Hyperviscosity—abnormal thickening of the blood
  • Endocarditis—an infection of the lining of the heart

Risk Factors

Certain chronic medical conditions can affect the health of your blood vessels. These conditions may increase your chances of TIA:
TIAs are more common in men than women in younger age groups. They are also more common in people age 45 years or older, with the highest risk between ages 60-80 years. Other factors that increase your chance for TIA include:

Symptoms

TIA symptoms occur abruptly. They usually last less than an hour but they may persist for up to 24 hours. The symptoms are different depending on the part of the brain that is affected. TIA symptoms are similar to those of a stroke and need immediate medical attention.
Symptoms may include:
  • Blindness in one eye, often described as a window shade dropping, and/or other visual problems
  • Weakness, numbness, or tingling of the face, arm, leg, or one side of the body (usually affects one side of the body, but there are exceptions)
  • Difficulty speaking or understanding words
  • Lightheadedness, unsteadiness of gait, or falling
  • Trouble with balance or coordination
  • Loss of consciousness
  • Nausea
  • Vomiting
  • Sudden confusion or loss of memory

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will carefully assess your blood pressure and nervous system. The main goal of tests or questions will be to determine your stroke risk.
Tests may include:

Treatment

A TIA places you at greater risk for having a stroke. The risk is actually highest in the first week after your TIA. Therefore, rapid treatment aims to decrease your risk of stroke. This can be done with lifestyle changes, medication, and surgery.

Lifestyle

Smokers must quit. Talk with your doctor about the smoking cessation programs.
People with diabetes, hypertension, and/or high cholesterol must make every effort to manage these conditions. It can be done with:
  • Regular exercise under the guidance of your doctor
  • Appropriate dietary changes—low in saturated fat, and rich in whole grains, fruits, and vegetables
  • Other lifestyle interventions, such as monitoring alcohol intake

Medications

The doctor may also prescribe medications to lower blood sugar, blood pressure, and cholesterol. This will help lower these risk factors.
To decrease the risk of clot formation your doctor may recommend antiplatelet agents such as aspirin.
If the blood clot came from your heart due to atrial fibrillation, anticoagulants may be prescribed.

Surgery

If you have at least a 70% blockage in your carotid artery (in your neck), doctors may recommend:
  • A carotid endarterectomy to remove the plaque deposits
  • Other less invasive procedures, such as intra-arterial stenting to widen an artery
These procedures have risks associated with them. Talk wth your doctor about your options.

Treatment of Underlying Conditions

If the cause of the TIA is a treatable condition, it must be promptly treated. Specific conditions that need further treatment include:
  • Atrial fibrillation
  • Severe anemia
  • Vasculitis

Prevention

To reduce your chance of TIA or stroke, take these steps:
  • Exercise regularly, with your doctor's approval.
  • Eat a healthy, balanced diet. It should be low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Maintain a healthy weight.
  • If you smoke, find out ways you can successfully quit.
  • Drink alcohol in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
  • Control blood pressure, high cholesterol, and diabetes if you have these conditions.

RESOURCES

American Heart Association http://www.heart.org

National Stroke Association http://www.stroke.org

CANADIAN RESOURCES

Canadian Society for Vascular Surgery http://canadianvascular.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.ca

References

Amarenco P, Bogousslavsky J, Callahan A III, et al; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-59.

FDA approves Pradaxa to prevent stroke in people with atrial fibrillation. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm230241.htm. Updated April 19, 2013. Accessed June 2, 2014.

Lutsep HL. MATCH results: implications for the internist. Am J Med. 2006;119:526.

NINDS Transient Ischemic Attack Information Page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/tia/tia.htm. Updated April 28, 2014. Accessed June 2, 2014.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 2, 2014. Accessed June 2, 2014.

Transient ischemic attack (TIA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 27, 2014. Accessed June 2, 2014.

6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Myint PK, Cleark AB, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014 Feb;45(2):373-382.

6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Imfeld P, Bodmer M, et al. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013 Sep 3;81(10):910-919.

Revision Information