Emergency: requires immediate attention
Transient ischemic attacks
Alerts and Notices
Synopsis
The pathophysiology of TIAs is thought to be due to reversible episodes of focal brain ischemia caused by the same mechanisms as in acute ischemic stroke:
- Cardioembolic disease (commonly atrial fibrillation)
- Large vessel disease (commonly atherosclerotic disease of the carotid arteries or vertebrobasilar arteries)
- Small vessel disease (lacunar stroke syndromes commonly due to long-standing hypertension and diabetes)
Common symptoms include hemi-weakness of the face, hand, arm, or leg, hemi-sensation loss, aphasia, dysarthria, dysphagia, dizziness, diplopia, monocular vision loss, and difficulty walking. Findings fit within a specific vascular territory or stroke syndrome.
Certain populations, such as children, are less likely to be affected; however, TIA / stroke should be considered in young patients with Moyamoya disease, congenital heart disease, bacterial endocarditis, sickle cell anemia, mitochondrial disease, or homocystinuria. Patients taking oral contraceptives or estrogen may be at a higher risk at a younger age.
Related topics: drug-induced stroke, cerebral stroke, cerebellar stroke
Codes
ICD10CM:G45.9 – Transient cerebral ischemic attack, unspecified
SNOMEDCT:
266257000 – Transient ischemic attack
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential for a transient and reversible episode of focal neurologic symptoms can include:- Migraine headache – Often presents as a headache with slowly progressing neurologic dysfunction, whereas TIAs tend to present without headache.
- Seizure with Todd's paralysis – TIAs typically do not present with seizure.
- Carotid or vertebral dissection – These can be very painful, whereas TIAs tend not to be painful.
- Hypoglycemia
- Hyperglycemia
- Benign paroxysmal vertigo
- Drug effect
- Conversion disorder – Tend to have examinations inconsistent with neurologic dysfunction and symptoms that do not fit a specific vascular pattern.
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Management Pearls
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Therapy
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References
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Last Reviewed:03/19/2018
Last Updated:09/29/2021
Last Updated:09/29/2021
Emergency: requires immediate attention
Patient Information for Transient ischemic attacks
Overview
A transient ischemic attack (TIA) is similar to a stroke when an artery of the brain becomes blocked (blood clot, high blood pressure) and stops blood flow to the brain. During a TIA the clogged blood vessel clears and symptoms resolve within a few minutes, causing no permanent damage. A blood clot, or embolism, can cause symptoms that lasts hours.While symptoms of a TIA and a stroke appear the same, a stroke can lead to permanent damage or death if not treated promptly. Because of the difficulty telling them apart, both require immediate medical attention.
Who’s At Risk
The following risk factors increase the likelihood of a TIA and stroke:- Prior TIA, blood clots, or family history of stroke
- Increased age, usually over 40
- African descent / black
- High blood pressure over 110/75
- High cholesterol
- Obesity
- Diabetes
- Heart disease, atherosclerosis (fatty-plaque buildup in arteries)
- Certain birth control pills
Other factors that have been found to increase risk of cardiovascular disease, TIA, and stroke:
- Smoking
- Inactive lifestyle
- Excessive alcohol consumption
- Unhealthy diet (high in fats, salt, sugar, etc.)
- Illicit drug use
Signs & Symptoms
The symptoms of a TIA resemble a stroke and include:- Paralysis, weakness, numbness on one side of the body (arm, face, leg)
- Slurred or incoherent speech
- Blindness or double vision (one eye, both eyes)
- Sudden intense headache
- Imbalance or lack of coordination
The FAST way to remember how to check for TIA or stroke symptoms:
- F (FACE WEAKNESS) – Is the face drooping on one side? Or uneven?
- A (ARM WEAKNESS) – Do arms held out in front appear uneven? Is one falling?
- S (SPEECH DIFFICULTY) – Is it hard to speak? Is speech slurred or nonsensical?
- T (TIME) – Don't waste time. If you have any of these signs, however short they last, immediately go by ambulance to a stroke center.
Self-Care Guidelines
To reduce your risk of a TIA, follow these guidelines:- Stop cigarette smoking
- Engage in physical activity for 30 minutes of moderate exercise most days of the week
- Limit alcohol intake
- Reduce salt, fat, and sugar intake
- Talk to your health care provider about which birth control pills carry less risk
When to Seek Medical Care
If symptoms develop, even if they stop in a few minutes, go to the hospital or call an emergency number (911) immediately. Because quick treatment is life-saving, it is now recommended to go promptly by ambulance to a stroke center hospital.Treatments
Your health care provider will help you control your blood pressure, diabetes, weight, cardiovascular disease, and other medical conditions to reduce your chance of repeat TIA or stroke.After your first TIA your health care provider may recommend some treatment to reduce the likelihood of another TIA. Antiplatelet drugs are used to prevent platelets in the blood from sticking together and forming a clot. Aspirin is the most commonly used anti platelet drug but your health care provider may also administer clopidogrel (Plavix).
Anticoagulants such as heparin (Coumadin) or warfarin (Jantoven) affect clotting proteins. Your health care provider may administer these drugs however they require close monitoring.
If you have a narrowed neck artery, your health care provider may suggest having a carotid endarterectomy in which fatty deposits and plaque are cleared from the carotid artery.