Learn about transient ischemic attack (TIA) symptoms, causes, and prevention. Get informed and find support on Meri Sehat.

Transient Ischemic Attack (TIA)

Humza Khizer

Overview

<p>Transient ischemic attack (TIA) is similar to a stroke but not quite. It is characterized by the temporary onset of stroke-like symptoms. TIA only lasts a few minutes and does not cause any permanent damage<sup><a href="#accordion">[1]</a></sup>.&nbsp;<br />
&nbsp;</p>

<p>Ministrokes or TIA are very common. Every 1 out of 3 people who have experienced TIA is bound to get a stroke later in life. It is also sometimes considered as a warning, triggered due to disruption in blood supply to the brain. TIA gets resolved within 24 hours<sup><a href="#accordion">[2]</a></sup>.</p>

<p>TIAs are very common after the age of 55 and are often treated as a predictor of a stroke since; in almost half the cases of TIA, the individual gets a stroke within 48 hours. 7.5-17.3% of sufferers of TIA are at risk of getting a stroke after their TIA episode within 3 months<sup><a href="#accordion">[3]</a></sup>.&nbsp;</p>

<p>Most low-income countries, especially Pakistan, suffer from cerebrovascular diseases. Despite the high prevalence of TIAs and strokes, there is little data available on the issue in South Asia. A study was carried out where individuals aged 35 or older were subjected to an investigation regarding their medical history. It was found that 19.1% of the population have had a stroke before and 9.7% of the people have had a TIA. Out of the affected individuals, 66.4% were females<sup><a href="#accordion">[4]</a></sup>.</p>

<div>&nbsp;</div>

Signs And Symptoms

<p>TIA has symptoms that are similar to normal stroke. These include:</p>

<ul>
	<li>Droopy eyes and face along with an inability to move facial muscles that involve smiling or speaking</li>
	<li>Inability to lift arms or keep them raised&nbsp;</li>
	<li>Numbness or weakness in arms</li>
	<li>Partial body paralysis</li>
	<li>Vision loss or blurred vision</li>
	<li>Dizziness&nbsp;</li>
	<li>Trouble with balance and coordination</li>
	<li>Dysphagia or difficulty swallowing</li>
</ul>

<div>&nbsp;</div>

Causes

<p>Just like a normal stroke, a TIA is caused whenever the brain is deprived of oxygen. This temporary disruption in the supply leads to the onset of symptoms that involve speech and visual disturbance.&nbsp;</p>

<p>The underlying cause is high cholesterol and its build up, which forms plaques or blood clots in arteries. Consequently, this blocks and delays the supply of oxygen and other nutrients to the brain<sup><a href="#accordion">[1]</a></sup>.&nbsp;</p>

<div>&nbsp;</div>

Diagnosis

<p>Diagnosis of TIA starts off with taking the patient&#39;s history and symptoms in detail. The target of the diagnosis is to deal with the underlying causes of the TIA and its treatment to avoid possible strokes in the future or at least decrease the chances of it. The following tests can be used to confirm the diagnosis and to prescribe the right treatment accordingly:&nbsp;<br />
&nbsp;</p>

<p><strong>Physical Exam: </strong>A physical and neurological examination is carried out to check eye movement, speech, language, reflexes, and strength. The patient is also checked for hypertension. The carotid artery present in the neck is also examined with the help of a stethoscope. A whooshing sound is associated with the presence of atherosclerosis. Some physicians use ophthalmoscopes, which can help find tiny fragments of cholesterol or even platelet fragments in the blood vessels at the posterior end of the eye.<br />
&nbsp;</p>

<p><strong>Blood Tests:</strong> The patient&rsquo;s cholesterol levels, blood glucose levels, and in some cases, levels of the amino acid homocysteine are also specified by the doctor. These tests are ordered to check for risk factors for stroke.<br />
&nbsp;</p>

<p><strong>CT Scan:</strong> A computerized tomography or computerized tomography angiography scanning is done by utilizing X-ray beams to create a 3D image of the brain to get a full picture of the arteries in the neck and brain.<br />
&nbsp;</p>

<p><strong>MRI:</strong>&nbsp;It is used to evaluate the arteries in the neck and brain.<br />
&nbsp;</p>

<p><strong>Carotid Ultrasonography:</strong> The carotid artery is examined through an ultrasound. A straight stick-like device, also known as a transducer, is used to send sound waves to the neck; how these waves travel and whether they are able to pass through or bounce back allows the examiner to come to a conclusive diagnosis<br />
&nbsp;</p>

<p><strong>Echocardiography:</strong> A transthoracic echocardiogram or a traditional echocardiography is very similar to carotid sonography where a transducer is used, but this time the sound waves are sent towards the heart, and the bouncing off of these waves is recorded and then examined.&nbsp;</p>

<p>A better and more accurate way of performing echocardiography is through a transesophageal echocardiogram. In this, a flexible probe with a built-in transducer is used and it is inserted inside the chest cavity through the esophagus. This causes the sound waves to reach the body with minimal interruptions and, hence, gives better results<sup><a href="#accordion">[5]</a></sup>.<br />
&nbsp;</p>

<p><strong>Arteriography:</strong> This procedure gives a view of arteries in the brain not normally seen in X-ray imaging and is used in special cases.</p>

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Treatment

<p>The extensive diagnostic tests are carried out to determine the root cause of the TIA. After the cause is known, the main target is not just to treat the issue at hand but also to treat the underlying problem in order to reduce any chances of stroke in the near future. The treatment involves<sup><a href="#accordion">[5]</a></sup>:<br />
&nbsp;</p>

<ul>
	<li><strong>Antiplatelet Drugs:</strong> When an injury is caused, our platelets tend to stick together to form clots to avoid excessive bleeding. However, in cases of stroke where blood clots are the culprits, anti-platelet drugs are used to ensure that the blood doesn&#39;t clot a lot. The most common and the cheapest type of antiplatelet drug is Aspirin. In many cases of TIA, Aspirin is given alongside clopidogrel. The combination of these 2 drugs is believed to prevent or at least reduce the chances of the individual getting a stroke. Other drugs like ticagrelor along with aspirin are also prescribed for at least 30 days sometimes, to reduce chances of stroke.<br />
	&nbsp;</li>
	<li><strong>Anticoagulants:</strong> Drugs like Heparin and Warfarin are used as they can act on several different proteins to inhibit the formation of clots. Heparin is not commonly used in the management of TIA&nbsp;though. Also, it must be mentioned that anticoagulants require close monitoring of the individual. Other anticoagulants like apixaban, dabigatran, rivaroxaban, edoxaban, etc.,&nbsp;may be preferred over warfarin by the physician if atrial fibrillation is observed in the individual.</li>
</ul>

<div>&nbsp;</div>

<p>Ministrokes may cause the following complications:</p>

<ul>
	<li>Blood clots</li>
	<li>Urinary tract infections</li>
	<li>Bed sores</li>
	<li>Trouble walking and frequent falling</li>
	<li>Difficulty swallowing</li>
</ul>

<div>&nbsp;</div>

<p>The following risk factors increase the chances of getting TIA:</p>

<ul>
	<li>Age &ndash; People over the age of 55 are more prone to TIA</li>
	<li>Gender &ndash; Males are usually at a higher risk of getting TIA; in Pakistan, studies suggest that more women suffer from the ministroke&nbsp;</li>
	<li>Smoking</li>
	<li>Hypertension</li>
	<li>Low Physical&nbsp;activity</li>
	<li><a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">Diabetes</a></li>
	<li>Heart issues</li>
	<li>Atrial fibrillation</li>
	<li>High <a href="https://www.merisehat.pk/disease/cholesterol#causes-5532" target="_blank">cholesterol </a>levels</li>
	<li>Obesity</li>
</ul>

<div>&nbsp;</div>

<p>Following are some preventive measures that can be taken:<br />
&nbsp;</p>

<ul>
	<li>Quit smoking</li>
	<li>Monitor the blood pressure carefully and consult a physician in case of any anomaly</li>
	<li>Monitor the cholesterol level and maintain it by following a healthy diet&nbsp;</li>
	<li>Limit red meat and carb intake</li>
	<li>Maintain weight and overall BMI</li>
	<li>Quit alcohol&nbsp;</li>
	<li>Quit smoking</li>
	<li>Increase physical activity</li>
</ul>

<div>&nbsp;</div>

<p>According to a study published in the Journal of American Stroke Association, women aged 35 or younger were 44% more likely to have ischemic strokes than men. While the reason behind these stats is still being researched, it is believed that the cause of these strokes among young adults is different from what is observed in people over 55 years of age. The study also sheds light upon the fact that the risk factors are less prevalent in younger women (35 years and below) compared to women aged 35 and above. Interestingly, it was also seen that young women who are survivors of ischemic stroke had worse outcomes compared to their male counterparts, emphasizing the need for further research on stroke in women<sup><a href="#accordion">[6]</a></sup>.&nbsp;<br />
&nbsp;</p>

Key Points

<ul>
	<li>Transient ischemic attack (TIA) is also known as a ministroke. It is characterized by stroke-like symptoms with interrupted oxygen supplied to the brain.</li>
	<li>TIAs are temporary and the effects last for a maximum of 24 hours.&nbsp;</li>
	<li>In Pakistan, the prevalence of TIA and stroke followed by TIA is very high and mostly women below 35 seem to suffer from it as compared to global stats, which suggest men are more prone to getting TIA.</li>
	<li>The disruption in the brain supply of blood and oxygen is due to many reasons; high blood pressure, <a href="https://www.merisehat.pk/disease/cholesterol#causes-5532" target="_blank">cholesterol</a>, and clot formation are considered as the main culprits.</li>
	<li>Combination therapy involving multiple antiplatelet drugs or anticoagulants are used after experiencing TIA to not just control the symptoms but also to avoid a <a href="https://www.merisehat.pk/disease/stroke" target="_blank">stroke</a>.</li>
	<li>Quitting smoking, and maintaining cholesterol levels and BMI are some ways to prevent TIAs.</li>
</ul>

<div>&nbsp;</div>

[1] Transient ischemic attack (TIA). Mayo Clinic.

[2] Transient Ischemic Attack. NHS choices.

[3] Degan D, Ornello R, Tiseo C, et al. Epidemiology of transient ischemic attacks using time- or tissue-based definitions. Stroke. 2017;48(3):530-536.

[4] Kamal AK, Itrat A, Murtaza M, et al. The burden of stroke and transient ischemic attack in Pakistan: A community-based prevalence study. BMC Neurology. 2009;9(1).