Transient Ischemic Attack (TIA)

Topic Overview

The brain

What is a transient ischemic attack?

A transient ischemic attack (TIA) 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 the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage. Some people call a TIA a mini-stroke, because the symptoms are those of a stroke but don't last long.

A TIA is a warning: it means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 or other emergency services right away. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.

What are the 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.

What causes a TIA?

A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. The clot can block blood flow to part of the brain. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. After the clot dissolves, blood flow returns, and the symptoms go away.

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 tests do you need after a TIA?

Your doctor will do tests to look at your heart and blood vessels. You may need:

Your doctor will also check to see if something else caused your symptoms.

How is a TIA treated?

Your doctor will start you on medicines to help prevent a stroke. You may need to take several medicines.

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.

How can you prevent another TIA or stroke?

After you have had a TIA, you are at risk for having another TIA or a stroke. But you can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.

Treat any health problems you have
  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends that you take aspirin or a blood thinner, take it. This can help prevent a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Adopt a healthy lifestyle
  • Don't smoke or allow others to smoke around you.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Stay at a healthy weight. Being overweight makes it more likely that you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, fish, and foods that are low in sodium, saturated fat, trans fat, and cholesterol.

Frequently Asked Questions

Learning about TIA:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with TIA:

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Cause

Blood clots that temporarily block blood flow to the brain are the most common cause of transient ischemic attacks (TIAs). Blood clots may develop for a variety of reasons.

  • A blood clot can form in an artery that supplies blood to the brain.
    • Blood clots usually form in arteries damaged by plaque buildup, which is a process called atherosclerosis. High blood pressure may damage arteries and cause plaque to build up.
    • Long-standing high blood pressure or diabetes may damage smaller blood vessels in the brain, causing a clot to form within the blood vessels and block blood flow.
  • A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to an artery that supplies blood to the brain. For example, clots may form:

Also, an artery that is partially blocked with plaque can reduce blood flow to the brain and cause symptoms.

Rare causes of blood clots that can cause a TIA include:

  • Clumps of bacteria, tumor cells, or air bubbles that move through the bloodstream.
  • Conditions that cause blood cells to stick together. For example, having too many red blood cells (polycythemia), abnormal clotting factors, or abnormally shaped red blood cells, such as those caused by sickle cell disease, may cause blood clots to form.
  • Inflammation in the blood vessels, which may develop from conditions such as syphilis, tuberculosis, or other inflammatory diseases.
  • A head or neck injury that results in damage to blood vessels in the head or neck.
  • A tear in the wall of a blood vessel located in the neck.

Symptoms

A transient ischemic attack (TIA) is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 or other emergency services right away. Early treatment can help prevent a stroke. If you think you had a TIA but your symptoms went away, you still need to call your doctor right away.

Symptoms of transient ischemic attacks (TIAs) occur suddenly and are always temporary. They usually go away in 10 to 20 minutes. TIA symptoms are just like stroke symptoms. They vary depending on which part of the brain is affected. Common symptoms of TIA 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.

What Happens

A transient ischemic attack (TIA) is a warning sign that a stroke may soon follow. Any symptoms of a TIA need to be treated as an emergency.

  • After a TIA, up to 10 out of 100 people will have a stroke in the next two days. And up to 17 out of 100 people will have a stroke within 90 days.1 The risk of stroke is highest in the first 30 days after a TIA.
  • A TIA happens before 15 out of 100 strokes.1

A TIA also may signal an increased risk for a heart attack. Atherosclerosis, which is hardening of the arteries, affects blood vessels throughout the body, including arteries that supply blood to the heart and brain. Atherosclerosis that affects the blood vessels in the heart (coronary arteries) may cause chest pain or a heart attack.

What Increases Your Risk

The risk factors (things that increase risk) for transient ischemic attack (TIA) and stroke include those you can treat or change and those you can't change.

Risk factors you can treat or change include:

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

Risk factors you cannot 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 those of other races.
  • Gender. Women have a higher risk of having a stroke in their lifetime compared to men. 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.1
  • Family history. The risk for TIA and stroke is greater if a parent, brother, or sister has had a stroke or a transient ischemic attack (TIA).
  • History of stroke or TIA.

When To Call a Doctor

Call 911 or other emergency services now if you have signs of a stroke:

  • 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 right away if you have:

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.

Who to see

The following doctors can diagnose and treat a transient ischemic attack (TIA):

Other specialists may be consulted if you need surgery or have other health problems:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Immediate evaluation is recommended if you have had or are having a transient ischemic attack (TIA). The purpose of evaluation is to:

  • Check for another cause of your symptoms, such as a stroke, low blood sugar (if you have diabetes), or Bell's palsy.
  • Look for a blood clot.
  • Find out whether you need a procedure to reopen a blocked artery.
  • Find out whether you need medicines to prevent blood clots.

Your doctor will ask you about your medical history and do a physical exam.

Tests to detect a TIA

If a TIA is suspected, the doctor may want to do tests, such as a:

  • CT scan of the head, to check for damage to the brain and to look for other disease, such as a tumor.
  • MRI scan, to check for damage to the brain and to look for other disease, such as a tumor.

Tests to find the cause of a TIA

Further tests are often done to identify the cause of the TIA. If blockage of the carotid arteries is suspected, you may have tests such as:

TIA symptoms may be due to blood clots caused by a heart problem. If heart problems are suspected, you may have tests such as a:

You may have other blood tests, such as a complete blood count (CBC), chemistry screen, and prothrombin time (INR) based on your age and medical history. Your doctor will use these tests to look for other causes of the TIA.

Treatment Overview

Getting help for a TIA

If you have symptoms of a transient ischemic attack (TIA), get medical help right away.

If you had symptoms of a TIA but you feel better now, you still need to see a doctor right away. A TIA is a sign that a stroke may soon follow. Prompt medical treatment may prevent a stroke.

Treatment for a TIA

If you've had a TIA, you may need further testing and treatment after you've been 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 a stroke or having surgery to reopen narrow arteries.

Medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.

If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy).

Preventing another TIA or stroke

Your treatment will also focus on preventing another TIA or stroke. This may include:

  • Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking medicines that lower blood pressure.
  • Taking aspirin or another antiplatelet medicine to prevent strokes. For more information, see Medications.
  • Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels in a target range. To do this, you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.

You may also need to make lifestyle changes such as quitting smoking, eating heart-healthy foods, and being more active. For more information, see Prevention.

Prevention

You can help prevent a transient ischemic attack (TIA) or stroke if you control risk factors and treat other medical conditions that can lead to a stroke.

Know your stroke risk

These are some of the common risk factors for stroke:

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor advises you to take aspirin or a blood thinner, take it. This can help prevent a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

  • Don't smoke or allow others to smoke around you. To learn more, see the topic Quitting Smoking.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, and foods that are low in sodium, saturated fat, trans fat, and cholesterol. Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best. These fish include salmon, mackerel, lake trout, herring, and sardines.

Home Treatment

Home treatment is not appropriate for a transient ischemic attack (TIA). If you think you are having a TIA, don't ignore the symptoms, and don't try to manage them at home. Call 911 or other emergency services right away. If you had symptoms of a TIA but they went away, you still need to see a doctor right away.

You can care for yourself at home by adopting healthy habits that help you prevent another TIA or stroke. To learn more, see Prevention.

Medications

Your doctor will probably prescribe several medicines after you have had a transient ischemic attack (TIA). Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

  • Antiplatelet medicines.
  • Anticoagulant medicines.

Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent TIAs and strokes.

Antiplatelet medicines

Antiplatelet medicines keep platelets in the blood from sticking together.

  • Aspirin (for example, Bayer) is most often used to prevent TIAs and strokes.
  • Aspirin combined with dipyridamole (Aggrenox) is a safe and effective alternative to aspirin.
  • Clopidogrel (Plavix) may be used for people who cannot take aspirin.
Click here to view an Actionset.Blood Thinners Other Than Warfarin: Taking Them Safely

Anticoagulants

Anticoagulants such as warfarin (for example, Coumadin) prevent blood clots from forming and 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. For more information, see the topic Atrial Fibrillation.

Statins

Statins lower cholesterol and can greatly reduce your risk for having another TIA or stroke. Statins even protect against stroke in people who do not have heart disease or high cholesterol.2

Blood pressure medicines

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

Surgery

When surgery is being considered after a transient ischemic attack (TIA), your age, prior overall health, and current condition are major factors in the decision.

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. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke.

Click here to view a Decision Point.Stroke: Should I Have Carotid Endarterectomy?

Other Treatment

Carotid artery stenting (also called carotid angioplasty and stenting) is sometimes done as an alternative to surgery to prevent a transient ischemic attack (TIA) or stroke.

In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a stent to keep the artery open.

Carotid artery stenting is not as common as carotid endarterectomy, a type of surgery.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
Web Address: www.ninds.nih.gov

CardioSmart
Web Address: www.cardiosmart.org

National Stroke Association
Web Address: www.stroke.org

References

Citations

  1. Go AS, et al. (2013). Heart disease and stroke statistics–2013 update: A report from the American Heart Association. Circulation, 127(1): e6–e245.
  2. Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.

Other Works Consulted

  • Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation, 97(5): 501–509. Also available online: http://circ.ahajournals.org/content/97/5/501.full.
  • Easton JD, et al. (2009). Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke, 40(6): 2276–2293. Also available online: http://stroke.ahajournals.org/cgi/reprint/40/6/2276.
  • ESPRIT Study Group (2006). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): A randomized controlled trial. Lancet, 367(9523): 1665–1673.
  • Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.
  • Lansberg MG, et al. (2012). Antithrombotic and thrombolytic therapy for ischemic stroke. Antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e601S–e636S. Also available online: http://journal.publications.chestnet.org/article.aspx?articleid=1159534.
  • Rothwell PM, et al. (2007). Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): A prospective population-based sequential comparison. Lancet, 370(9596): 1432–1442.
  • Skinner JS, Cooper A (2011). Secondary prevention of ischaemic cardiac events, search date May 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
  • U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Revised August 26, 2013

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