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Transient ischemic attack (TIA)
Alternative namesMini stroke; TIA; Little stroke
DefinitionA transient ischemic attack is a "mini-stroke" caused by temporary disturbance of blood supply to an area of the brain, resulting in a sudden, brief decrease in brain function. (It lasts less than 24 hours, usually less than one hour) .
Causes, incidence, and risk factors
A transient ischemic attack (TIA) is caused by an interruption of blood flow to brain cells. If the symptoms resolve completely in under 24 hours, this is called a TIA or "mini stroke." If the symptoms do not resolve, the event is called a stroke.
A brief interruption to the blood flow can cause a decrease in brain function (neurologic deficit). Symptoms vary with the area of the brain affected and may include changes in vision, speech or comprehension, vertigo, decreased movement or sensation in a part of the body, or changes in the level of consciousness. If the blood flow is decreased for a sufficient period, brain cells in the area die (infarct), causing permanent damage to that area of the brain or even death.
The loss of blood circulation to the brain can be caused by the following:
Atherosclerosis ("hardening of the arteries") is a condition where fatty deposits occur on the inner lining of the arteries, which dramatically increases the risk for both TIAs and stroke. Atherosclerotic plaque is formed when damage occurs to the lining of an artery. Platelets clump around the area of injury as a normal part of the clotting and healing process. Cholesterol and other fats also collect at this site, forming a mass within the lining of the artery. A clot (thrombus) may form at the site of the plaque, triggered by irregular blood flow in this location, and the thrombus may then block blood vessels in the brain.
Pieces of plaque or clots can also break off and travel through the bloodstream from distant locations, forming an embolus that can occlude the small arteries, causing TIAs.
About one-third of the people diagnosed with TIA will later have a stroke. However, about 80 to 90% of people who have a stroke secondary to atherosclerosis had TIA episodes before their stroke. Approximately one-third of the people with TIA will have recurrent TIAs, and one-third will have only a single episode of TIA. The age of onset varies, but incidence rises dramatically after age 50. TIA is more common among men and African-Americans.
Less common causes of TIA include blood disorders (including polycythemia, sickle cell anemia, and hyperviscosity syndromes where the blood is very thick), spasm of the small arteries in the brain, abnormalities of blood vessels caused by disorders such as fibromuscular dysplasia, inflammation of the arteries (arteritis, polyarteritis, granulomatous angiitis), systemic lupus erythematosus, and syphilis. Hypotension (low blood pressure) may precipitate symptoms in an individual with a pre-existing vascular lesion.
Other risks for TIA include high blood pressure (hypertension), heart disease, migraine headaches, smoking, diabetes mellitus, and increasing age.
Symptoms of TIA are the same as those that occur in stroke and include the sudden development of:
Additional symptoms that may be associated with this disease:
Note: Symptoms begin suddenly, last only a short time (from a few minutes to 24 hours) and disappear completely. Symptoms may occur again at a later time. Specific symptoms vary depending on the location (which vessel is involved), the degree of vessel involvement, and the extent of collateral circulation. Symptoms usually occur on the same side of the body if more than one body part is involved.
Signs and tests
A detailed and complete history is vital to the diagnosis, because the specific deficits demonstrated help the physician determine which area of the brain was affected. Often, the diagnosis may rest on the history alone, as symptoms and signs may have completely disappeared by the time one gets to the hospital.
A physical examination should include a neurologic examination, which may be abnormal during an episode but normal after the episode has passed. It may also be used to rule out a stroke in evolution rather than TIA. Blood pressure may be high. Listening with a stethoscope over the carotid or other artery may show a bruit, an abnormal sound caused by irregular blood flow, which may indicate atherosclerotic plaque or a thrombus in the area.
Tests for TIA may include tests to determine the cause and extent of blood vessel involvement, and to rule out stroke or other disorder that may cause the symptoms.
Other tests and procedures may be performed to determine underlying disorders and to rule out other disorders that may cause the symptoms. This may include examination for hypertension , heart disease , diabetes , high blood lipids , vasculitis, and peripheral vascular disease . These tests and procedures may include:
The goal is to improve the arterial blood supply to the brain and prevent the development of a stroke .
Treatment of recent TIA (within the prior 48 hours) usually requires admission to the hospital for evaluation of the specific cause and determination of long-term treatment. Underlying disorders should be treated appropriately, including such disorders as hypertension , heart disease , diabetes , arteritis, and blood disorders.
Smoking should be stopped.
Treatment of symptoms of blood disorders (such as erythrocytosis , thrombocytosis, or polycythemia vera , which include an increase in the number of some of the cellular components of blood) may include phlebotomy, hydration, and treatment of the underlying (causative) blood disorder. Antihypertensive medications may be used to control high blood pressure . Medications to lower cholesterol may be useful in reducing high blood cholesterol levels.
Expectations (prognosis)By definition, an episode of TIA is brief and recovery is complete. It may recur later that same day or at a later time. Some people have only a single episode, some have recurrent episodes, and some will have a stroke . A TIA needs to be treated as aggressively as a stroke would, as any given TIA could develop into a stroke.
Calling your health care providerTIA is a medical emergency. Call 911 or other local emergency number immediately. Do not ignore symptoms just because they resolve! They may be a warning of an impending stroke . Even if symptoms resolve completely, it is important to call your healthcare provider or an emergency number and get immediate medical attention.
PreventionPrevention of TIA includes controlling the risk factors. Hypertension , diabetes , heart disease , and other associated disorders should be treated as appropriate. Smoking should be stopped or minimized. The use of blood thinners may prevent strokes in some patients who have blood clots or atrial fibrillation. Carotid endarterectomy in select patients may prevent stroke.
Update Date: 11/17/2002Joseph V. Campellone, M.D., Division of Neurology, Cooper Hospital/University Medical Center, Camden, NJ. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT