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Transient Ischemic Attack (TIA)

Condition Basics

What is a transient ischemic attack (TIA)?

A transient ischemic attack (TIA) is an event that happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and symptoms go away. Symptoms are the same as a stroke but don't last long and don't cause lasting damage.

What causes it?

A TIA happens when there's a blockage in a blood vessel. It can block blood flow to part of the brain. The blockage can form when blood vessels are damaged by high blood pressure or high cholesterol. A blood clot can also travel to the brain from another location, like the heart or blood vessels in the neck.

What are the symptoms?

Symptoms of a TIA may include numbness or weakness in the face or an arm or leg, vision changes, trouble speaking, confusion, or problems with walking or balance. Symptoms usually last for 10 to 20 minutes.

How is it diagnosed?

Your doctor asks you about your medical history and does a physical exam. You may have tests, like a CT scan of the head or an MRI. These tests check for damage to the brain and other diseases, such as a tumor. Other tests are often done to find the cause of the TIA.

How is a TIA treated?

If you've had a TIA, your doctor will start you on medicines to help prevent a stroke. If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may need a procedure to open them up. This can help prevent blood clots that block blood flow to your brain.

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Cause

A TIA happens when there is a blockage in a blood vessel. It can block blood flow to part of the brain. The blockage can form when blood vessels are damaged by high blood pressure or high cholesterol. A blood clot can also travel to the brain from another location, such as the heart or blood vessels in the neck.

Brain cells are affected within seconds of the blockage. This causes symptoms in the parts of the body that are controlled by those cells.

Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a "low-flow" TIA. It is not as common as other types.

What Increases Your Risk

A risk factor is anything that makes you more likely to have a particular health problem. Some of the risk factors for a TIA and stroke are things you can treat or change. These include:

  • High blood pressure (hypertension).
  • Atrial fibrillation.
  • Diabetes.
  • Smoking.
  • High cholesterol.
  • Heavy use of alcohol.
  • Being overweight.
  • Physical inactivity.

Risk factors you can't change include:

  • Age. The risk of TIA and stroke increases with age.
  • Race. African Americans, Native Americans, and Alaskan Natives have a higher risk than people of other races.
  • Gender. Women have a higher risk for stroke than men do. In people ages 55 to 75, about 2 out of 10 women will have a stroke and 1 or 2 out of 10 men will have a stroke.
  • Family history of TIA or stroke. Your risk for TIA and stroke is greater if a parent, brother, or sister has had a stroke or TIA.
  • Personal history of TIA or stroke.

Prevention

Here are some ways to reduce your risk of having another TIA.

  • Work with your doctor to treat any health problems you have. High blood pressure, high cholesterol, atrial fibrillation, and diabetes all raise your chances of having a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • Have a healthy lifestyle.
    • Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor. Smoking makes a stroke more likely.
    • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
    • Lose weight if you need to. A healthy weight will help you keep your heart and body healthy.
    • Be active. Ask your doctor what type and level of activity are safe for you.
    • Eat heart-healthy foods, like fruits, vegetables, and high-fiber foods.

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Symptoms

Symptoms of a TIA are the same as symptoms of a stroke. But symptoms of a TIA don't last very long. Most of the time, they go away in 10 to 20 minutes. They may include:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.

If you have any of these symptoms, call 911 or other emergency services right away.

Ask your family, friends, and coworkers to learn the signs of a TIA. They may notice these signs before you do. Make sure they know to call 911 if these signs appear.

What Happens

A TIA usually doesn't cause any lasting problems. But it is a serious warning sign of a possible stroke in the future. If you have other medical conditions such as coronary artery disease or atherosclerosis, you may also have an increased risk for a heart attack. Talk to your doctor about your risk. Understanding your risk will help you and your doctor plan your treatment options.

You can do a lot to lower your chance of having another TIA or a stroke. Medicines can help, and you may also need to make lifestyle changes.

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When to Call a Doctor

Call 911 or other emergency services immediately if you have signs of a stroke, such as:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body
  • Sudden vision changes
  • Sudden trouble speaking
  • Sudden confusion or trouble understanding simple statements
  • Sudden problems with walking or balance

Call your doctor now if you have:

  • Recently had symptoms of a transient ischemic attack (TIA), even if the symptoms are gone now.
  • Any signs of bleeding and you are taking aspirin or other medicines that prevent blood clotting.

Call your doctor today if you think you have had a TIA in the past and have not yet talked with your doctor about your symptoms.

Exams and Tests

You need to be checked by a doctor right away if you have had or are having a TIA. Your doctor will ask you about your medical history and do a physical exam. The exam results may be normal if the symptoms have already gone away.

If a TIA is suspected, the doctor may want to do tests. The tests include a CT scan of the head or an MRI to check for brain damage and look for diseases.

More tests are often done to find the cause of the TIA. This may include:

  • An electrocardiogram (ECG, EKG) to check for heart rhythm problems that can lead to blood clots.
  • An echocardiogram (echo) to look for clots or heart problems.
  • Tests that check for blockage in blood vessels of the neck, such as an ultrasound, a magnetic resonance angiogram (MRA), a CT angiogram, or an angiogram.
  • Certain blood tests.

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Treatment Overview

If you've had a TIA, you may need more testing and treatment after you get checked by your doctor. If you have a high risk of stroke, you may have to stay in the hospital for treatment.

Your treatment for a TIA may include taking medicines to prevent blood clots or a stroke, or having surgery to reopen narrow arteries.

Self-Care

Medicines

  • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • If you take a blood thinner, such as aspirin, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
  • Call your doctor if you are not able to take your medicines for any reason.
  • Do not take any over-the-counter medicines or herbal products without talking to your doctor first.
  • If you take birth control pills or hormone therapy, talk to your doctor. Ask if these treatments are right for you.

Lifestyle changes

  • Do not smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines.
  • Be active. If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week. You also may want to swim, bike, or do other activities.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, lean meats, beans, peas, nuts, seeds, and soy products, and foods that are low in sodium, saturated fat, and trans fat.
  • Stay at a healthy weight. Lose weight if you need to.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

Staying healthy

  • Manage other health problems such as diabetes, high blood pressure, and high cholesterol.
  • Get the flu vaccine every year.

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Medicines

Your doctor will probably prescribe several medicines after you've had a TIA. Medicines to prevent blood clots are often used. This is because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

  • Antiplatelets.
  • Anticoagulants.

Medicines to lower cholesterol and blood pressure are also used to prevent TIAs and strokes.

Antiplatelet medicines

Antiplatelet medicines keep platelets in the blood from sticking together. They include:

  • Aspirin (such as Bayer).
  • Aspirin combined with dipyridamole (Aggrenox).
  • Other antiplatelet medicines, such as clopidogrel (Plavix).

Anticoagulants

Anticoagulants such as warfarin (for example, Coumadin) prevent blood clots from forming. And they keep existing blood clots from getting bigger.

You may need to take this type of medicine after a stroke if you have atrial fibrillation or another condition that makes you more likely to have another stroke.

Cholesterol medicines

Statins and other medicines, such as ezetimibe, lower cholesterol and the risk for a TIA or stroke.

Blood pressure medicines

If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:

  • Angiotensin II receptor blockers (ARBs).
  • Angiotensin-converting enzyme (ACE) inhibitors.
  • Beta-blockers.
  • Calcium channel blockers.
  • Diuretics.

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Surgery

If you have serious blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries.

Carotid artery stenting is sometimes done instead of surgery to prevent a TIA or stroke. It's also called carotid angioplasty and stenting. A doctor uses a thin tube called a catheter. The tube is put into an artery in your groin. It is threaded up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed part of the artery and places a stent to keep the artery open.

When a procedure is being considered after a TIA, the benefits and risks must be carefully weighed because the procedures may cause a stroke. Factors in the decision about having a procedure include your age, prior overall health, and current condition.

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Credits

Current as of: July 6, 2021

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
Richard D. Zorowitz MD - Physical Medicine and Rehabilitation