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Transient Ischemic Attack (TIA)

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Overview

A transient ischemic attack, or TIA, is a brief episode of stroke-like symptoms. It indicates a temporary (transient) reduction in blood supply to an area of the brain. When there is not enough blood flow, brain cells malfunction and begin to die (ischemia). The majority of TIAs are brief and don’t result in long-term harm.

Similar to an ischemic stroke, a transient ischemic attack is a medical emergency. This is because there is no way to predict how long a transient is going to last and every minute counts. Seek immediate medical attention if someone displays stroke symptoms, such as drooping arms and face, poor speech, vision changes, or balance issues.

Experiencing a TIA, also referred to as a ministroke, should be a cause for significant concern. It is important to note that approximately 1 in 3 TIA patients are at risk of eventually suffering a full-blown stroke, with around half of these strokes occurring within a year following the initial TIA episode. Moreover, aside from serving as an opportunity for timely intervention and treatment, a TIA can also function as a critical warning sign for a potential future stroke.

Symptoms

Transient ischemic attacks often last for a short period of time. While uncommon cases may result in symptoms lasting up to 24 hours, the majority of signs and symptoms go away in an hour. Early-stage symptoms of a stroke are similar to those of a transient ischemic attack (TIA), which might include sudden onset of:

  • Weakness, numbness, or paralysis, usually on one side of the body, in the arm, leg, or face
  • Difficulty understanding others or slurred speech.
  • sudden loss of one or more senses (hearing, taste, smell, vision, and touch), either completely or partially.
  • Loss of balance, vertigo, or coordination
  • Memory loss.
  • Sudden headache.

The patient may experience many transient internal seizures (TIAs), with repeated signs and symptoms that vary depending on the specific brain region affected.

Transient ischemic attacks (TIAs) usually occur hours or days before a stroke, therefore it’s important to get medical assistance as soon as possible.

Causes

An ischemic stroke, the most common kind of stroke, has similar causes as a transient ischemic attack. Part of the brain’s blood supply is cut off during an ischemic stroke due to a clot. A transient ischemic attack (TIA) does not result in permanent damage and the blockage is temporary.

Atherosclerotic plaques, characterized by the buildup of cholesterol-laden fat deposits, tend to amass in the arteries or their branches responsible for supplying the brain with vital oxygen and nutrients. These plaques often serve as the primary underlying cause of transient ischemic attacks (TIAs).

These plaques have the potential to induce the formation of blood clots or restrict the flow of blood within an artery. Additionally, a TIA can be triggered when a blood clot from another part of the body, typically the heart, travels to an artery that provides blood to the brain.

Risk factors

A TIA may be caused by or more likely to occur as a result of numerous circumstances. The following risk factors for a TIA and stroke cannot be changed by the patient. However, being aware of their risk may encourage them to alter their way of life in order to lower additional risks. Among the risk factors are:

  • Family history: If a family member has suffered a stroke or TIA, the risk could be higher.
  • Age: As the patient ages, the risk increases, particularly around age 55.
  • Sex: A TIA and a stroke are slightly more common in men. However, the risk of stroke increases with age in women.
  • History of transient ischemic attack: An increased risk of stroke occurs if the patient has experienced one or more TIAs.
  • Sickle cell disease: One of the most common side effects of sickle cell disease is stroke. Blood vessels with a sickle form tend to clog arteries and carry less oxygen, which reduces blood flow to the brain. On the other hand, people can reduce their risk of stroke by receiving the right treatment for sickle cell disease.
  • Controllable risk factors: Many factors, such as specific medical disorders and lifestyle decisions, can be managed or controlled by the patient to lower their risk of stroke. A person’s likelihood of having a stroke rises if they have two or more of these risk factors, although having one or more of them does not guarantee it.
    • Weight: Obesity raises the risk of stroke in both men and women, particularly when it involves excess weight around the abdomen.
    • Tobacco usage: For a lower chance of a TIA and stroke, give up smoking. Atherosclerosis, or the buildup of cholesterol-containing fatty deposits in the arteries, is one of the risks associated with smoking, along with blood clots and abnormal blood pressure.
    • Physical activity: Regularly completing 30 minutes of moderate-intense exercise lowers risk.
    • Poor nutrition: Lowering salt and fat intake also lowers the risk of stroke and transient ischemic attack.
    • Alcohol intake: If the patient drinks, they should restrict their intake to no more than two drinks for men and one drink for women each day.
    • Illegal drugs: Don’t use cocaine or any other illegal substances.
    • High cholesterol: Reducing cholesterol and fat intake, particularly trans and saturated fat, may help to lessen artery-clogging plaque. A statin or other cholesterol-lowering medicine may be prescribed by the healthcare provider if the patient’s cholesterol cannot be controlled by dietary modifications alone.
    • High blood pressure: When blood pressure measurements exceed 140/90 millimeters of mercury (mm Hg), the risk of a stroke increases. The patient and the healthcare provider will choose an appropriate target blood pressure based on the patient’s age, the presence of diabetes, and other relevant considerations.
    • Diabetes: Atherosclerosis is a condition in which fatty deposits build up in the arteries, narrowing them. Diabetes makes this condition worse and progress more quickly.
    • Cardiovascular disease: This includes abnormal cardiac rhythms, heart defects, infections, and heart failure.
    • Carotid artery disease: This disease causes blockages in the neck blood arteries that supply the brain.
    • Peripheral artery disease (PAD): The blood arteries that supply blood to the arms and legs clog as a result of PAD.
    • High homocysteine level: Increased blood concentrations of this amino acid can lead to artery scarring and thickening, which increases the risk of blood clots.

Diagnosis

In order to determine the origin of the TIA and the best course of treatment, a quick assessment of the symptoms is essential. A healthcare provider may utilize the following information to help identify the TIA’s cause and gauge the patient’s risk of having a stroke:

  • Physical exam and tests. The healthcare provider will conduct both a neurological and physical examination. The vision, eye movements, speech and language, strength, reflexes, and sensory system will all be assessed by the healthcare provider. They might listen to the carotid artery in the neck using a stethoscope. A whooshing sound, or bruise, could be a sign of atherosclerosis. Alternatively, a healthcare provider might use an ophthalmoscope to search the retina’s tiny blood veins at the back of the eye for cholesterol or platelet fragments, or emboli.
    The healthcare provider may perform an examination for risk factors associated with stroke, such as high blood pressure, high cholesterol, diabetes, and in certain situations, elevated homocysteine levels, among others.
  • Carotid ultrasonography: A carotid ultrasound may be recommended if the healthcare provider believes that the TIA may have been caused by the carotid artery. A transducer, which resembles a wand, inserts high-frequency sound waves into the neck. A healthcare provider can examine images on a screen to check for carotid artery constriction or clotting after sound waves travel through tissue and return.
  • Computerized tomography (CT) or computerized tomography angiography (CTA): X-ray beams are used in CT scanning of the head to analyze the arteries in the neck and brain or to create a composite 3D image of the brain. Similar to a traditional CT scan, CTA scanning involves X-rays but also the possible injection of a contrast substance into a blood artery. A CTA scan, in contrast to a carotid ultrasonography, may assess blood arteries in the head and neck.
  • Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA): By using a powerful magnetic field, these procedures are able to provide a three-dimensional composite image of the brain. While MRA may include injecting a contrast material into a blood vessel, it uses technology akin to MRI to assess the arteries in the neck and brain.
  • Echocardiography: A healthcare provider may decide to conduct a transthoracic echocardiogram (TTE), a type of conventional echocardiography. During a transducer therapy, an instrument known as a transducer is moved across the chest. A transesophageal echocardiogram (TEE), a distinct kind of echocardiography, may be performed by a healthcare provider in place of the transducer, which produces an ultrasound image by reflecting sound waves off various areas of the heart. A flexible probe with an integrated transducer is inserted into the esophagus, the tube that connects the stomach to the back of the mouth, during a transesophageal echocardiogram (TEE).
    Ultrasound pictures can be produced with greater clarity and detail since the esophagus is situated immediately behind the heart. This makes certain objects, such blood clots, easier to identify that might not be apparent during a conventional echocardiogram examination.
  • Arteriography: This technique provides an image of the brain’s arteries that is not often visible with X-ray imaging. Through a small incision, usually in the groin, a radiologist inserts a thin, flexible tube called a catheter.
    Manipulating the catheter into the carotid or vertebral artery requires passing it through the major arteries. To produce X-ray images of the brain’s arteries, the radiologist then inserts a dye through the catheter. In some situations, this process might be applied.

Treatment

Upon identifying the underlying cause of a TIA, the primary objective of treatment is to effectively address the issue and prevent the occurrence of a full-fledged stroke. Depending on the specific cause of the TIA, healthcare providers may recommend surgical interventions or balloon procedures such as angioplasty. Alternatively, they may prescribe medications aimed at reducing the risk of blood clot formation. The choice of treatment approach is tailored to the individual circumstances and contributing factors of the TIA.

  • Medications: Following a TIA, healthcare providers use a variety of medications to reduce the risk of a stroke. The location, etiology, severity, and kind of TIA all influence the treatment that is chosen. A healthcare provider might recommend:
    • Blood pressure medication: They lessen internal blood vessel pressure and strain. ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, diuretics, and other medications are frequently used to treat this.
    • Anti-platelet drugs: One of the circulating blood cell types, platelets, are less likely to clump together when taking these medications. Sticky platelets that have been wounded in blood arteries start to coagulate, and blood plasma proteins finish the clotting process.
      Aspirin is the anti-platelet medication that is most commonly utilized. The cheapest priced treatment with the fewest possible side effects is aspirin. Aspirin can be substituted with the anti-platelet medication clopidogrel (Plavix).
    • As an alternative, to lower the risk of recurrent stroke, a healthcare provider may prescribe aspirin plus ticagrelor (Brilinta) for 30 days. If they want to lower blood clotting, they might prescribe Aggrenox, which is a combination of low-dose aspirin and the anti-platelet medication dipyridamole. Dipyridamole functions somewhat differently from aspirin.
    • Anticoagulants: These medications inhibit the clotting of blood, hence reducing the possibility of a clot developing and becoming lodged in a cerebral blood vessel. Heparin and warfarin (Jantoven) are examples of these medications. The effect they have is on clotting-system proteins rather than platelet activity. The treatment of transient ischemic attacks (TIAs) seldom involves the short-term administration of heparin.
      These medications need to be monitored closely. The healthcare provider may recommend a direct oral anticoagulant, which may be less risky than warfarin, if atrial fibrillation is detected. Examples of these medications include apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), or dabigatran (Pradaxa).
    • Statins: Medication that lowers cholesterol is called a statin. In general, they lower blood levels of low-density lipoprotein (LDL) cholesterol. That is the type of cholesterol that can accumulate inside blood vessels, producing atherosclerosis and blood vessel narrowing.
  • Angioplasty: Carotid angioplasty, also known as stenting, is a technique that can be considered in certain situations. In order to keep a blocked artery open, a tiny wire tube known as a stent is inserted into the artery after it has been opened using a balloon-like device.
  • Surgery: The healthcare provider may recommend a carotid endarterectomy if the patient has a moderately or severely narrowed neck (carotid) artery. By removing atherosclerotic plaques from the carotid arteries, this prophylactic procedure stops another TIA or stroke from happening. The artery is opened by making an incision, the plaques are taken out, and the artery is shut.

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Diseases & Conditions Transient Ischemic Attack (TIA)