Transient Ischemic Attack (TIA)

A transient ischemic attack refers to a short episode of brain dysfunction caused by a disruption of blood flow to the nervous system. It is also known as a mini-stroke and is different from a stroke because the episode does not cause the death of the brain cells and is usually less than an hour. The symptoms are similar to that caused by a stroke and include weakness of any part of the body, affecting movement, sensations, vision, speech, cognition, etc. TIA can be considered an alarming event before a true stroke, and treatments to prevent a stroke should be started. 

Like other body organs, your brain also requires an efficient blood supply to work properly. Some factors can lead to difficulties in the blood supply affecting the viability of the tissues and so the working. Atherosclerosis of the blood vessels (thickening due to plaque deposition) supplying the brain and spinal cord can cause disruption of the blood flow. Sometimes a blood clot (thrombus) formed at other vessels can break off and reach the brain blood vessels by flowing through the blood resulting in obstruction of the vessel. It is called an embolus. Other causes may include arteritis (inflammation of the arteries), hypercoagulable states, and the use of sympathomimetic drugs, for example, cocaine.

In the United States, around 2-5 million cases of TIA are diagnosed every year. The likelihood of TIAs increases with age. It is found more in men. TIAs have a higher incidence in African Americans. 

Some of the factors that can increase your risk of having a TIA include;

·         Old age

·         Family history of stroke

·         Being a male

·         Having co-morbid diseases like hypertension (high blood pressure), diabetes, and heart diseases.

·         Smoking

·         High levels of cholesterol

·         Obesity

·         Drug abuse

The symptoms of a transient ischemic attack (TIA) are similar to a stroke but last less than an hour. They include;

·         Decreased levels of vision affecting one or both eyes

·         Numbness or weakness on one side of the body

·         Severe headache

·         Difficulty in walking

·         Feeling Dizzy

·         Loss of balance and coordination

·         Difficulty in speech

·         Confusion 

If you suspect having TIA, you must immediately contact your healthcare provider. They will obtain a detailed history and will perform a physical examination with a special focus on the central nervous system. Your doctor may illicit a few physical tests to evaluate your vision, speech, movements, and sensations. They may also examine your heart for murmurs and take readings for your blood pressure. You may be advised to undergo the following investigations for the confirmation of diagnosis.

Blood tests: Risk factors for atherosclerosis may need to be checked by assessing the blood for the presence of cholesterol, diabetes, hypercoagulability, and amino acid homocysteine.

Computerized tomography (CT scan) of head and neck:  CT scan is the procedure that uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries of the neck. It may involve the use of a contrast material to be injected into a vein and generate images.

Magnetic resonance imaging (MRI scan) of the brain and spinal cord: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. 

Magnetic resonance angiography (MRA): This procedure involves the use of a contrast material to be injected into the blood vessel to visualize the arteries of the brain and the neck.

Carotid ultrasonography: In this procedure, ultrasound waves are used to generate images to check for the condition of the carotid artery. 

Transthoracic echocardiography: It is an ultrasound of the heart in which a probe delivering high-frequency sound waves is placed on your chest to generate the images of the heart.

Transesophageal echocardiography: It is a type of echocardiogram that is performed through the esophagus. A transesophageal echocardiogram may be recommended if more precise pictures of your heart are required. A thin pipe holding the sensor is directed down your throat and into the tube that connects your mouth and stomach (esophagus). The procedure is carried out when you are anesthetized.

Some of the disorders related to TIAs include;

·         Stroke

·         Seizure

·         Tumor or mass lesion in the central nervous system

·         Migraine with aura

·         Peripheral nerve disorder

·         Intracranial hemorrhage

·         Meningitis

·         Subarachnoid hemorrhage

·         Multiple Sclerosis

A TIA can be a warning for a stroke hence the treatment includes strategies that will prevent a future stroke. This includes treating the risk factors and the conditions predisposing to a stroke.

Treatment of diabetes: If you have diabetes type 2, your doctor will prescribe some medications to control blood sugar levels. These medicines include Biguanides (Metformin), Thiazolidinediones (Rosiglitazone), etc.

Treatment of Hypertension: If you have high blood pressure, your doctor will prescribe medicines for controlling your blood pressure. These medicines include; Diuretics (Thiazide) and ACE inhibitors (Captopril, Enalapril), etc.

Management of increased Cholesterol levels: You may be prescribed medicines to control the blood levels of triglycerides and cholesterol. These medicines include; Statins (Atorvastatin, Rosuvastatin), Niacin, Fenofibrates, etc.

Anti-platelet drugs: They are also known as blood thinners and include Aspirin and Clopidogrel. They prevent platelet sticking and plaque formation in place of tissue injuries caused by fatty deposits.

Anti-coagulants: These medicines include Heparin and Warfarin which exert their effects by working on the coagulation system. The side effects of using these medicines include bleeding episodes. So their levels in the blood need to be closely monitored via repeated blood tests to prevent hemorrhages.

Procedures for Carotid artery: If the carotid artery that supplies blood to the brain shows signs of atherosclerosis, surgical procedures may be needed to remove the plaques, namely, Carotid Endarterectomy and Carotid Angioplasty and stenting. 

The risk of a stroke is very high after a TIA so all patients are advised to use the medicines prescribed by their doctor. Stroke causes severe disability and can even cause death. 

The best way to prevent a TIA and strokes is to learn about the risk factors and adopt some lifestyle changes to manage them;

• Take regular treatment and follow-ups for conditions like diabetes, hypertension, and hyperlipidemia.
• Get to know your family history and adopt healthy lifestyle changes from the beginning.
• Avoid smoking.
• Consume a healthy diet rich in vitamins, minerals, Omega 3 fatty acids, and antioxidants, and avoid sugary, fatty, and fried food.
• Employ regular exercises or a brisk walk for at least 30 minutes daily to improve muscular activity, maintain a healthy weight, and overall body functions.
• Use different strategies like meditation, yoga, or breathing exercises to learn to manage stress.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on June 01, 2023.

References

TIA (Transient Ischemic Attack) | American Stroke Association

https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack

Frontiers | The Impact of Transient Ischemic Attack (TIA) on Brain and Behavior (frontiersin.org)

https://www.frontiersin.org/articles/10.3389/fnbeh.2019.00044/full