What Is a Transient Ischemic Attack (TIA)?
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A transient ischemic attack (TIA), also called a mini-stroke, occurs when blood flow to part of the brain stops for a short period of time.
While a TIA can mimic the symptoms of a stroke, the symptoms of a TIA last only a few minutes at most — the average length of a TIA is about one minute.
Additionally, unlike a stroke, most TIAs don’t cause permanent damage.
However, a TIA should be taken seriously.
Causes of TIA
The reason a TIA occurs is usually one of the following:
- Low blood flow at a narrow part of a major artery carrying blood to the brain
- A blood clot in another part of the body (such as the heart) breaks off, travels to the brain, and blocks a blood vessel in the brain
- Plaque build-up which decreases the blood flow through an artery or leads to the development of a clot
Risk Factors for TIA
The following factors may increase your risk for TIA:
Family History If a family member has had a TIA or a stroke, you’re at greater risk.
Age As you get older, and especially after 55, your risk of a TIA increases.
Gender While men are at a slightly greater risk of TIA and stroke, more than half of deaths from stroke occur in women.
Race African Americans have a higher risk of dying from stroke, partly because high blood pressure and diabetes are more prevalent in this population.
Sickle Cell Anemia TIA is a complication associated with sickle cell anemia.
High Blood Pressure If your high blood pressure is uncontrolled, your risk of stroke increases.
High Cholesterol Eating high cholesterol foods and foods high in saturated and trans fats can contribute to plaque build-up in your arteries.
Cardiovascular Disease Heart failure, a heart defect, a heart infection, or an abnormal heart rhythm can increase your chances of a stroke.
Carotid Artery Disease With this disease, the blood vessels in your neck that lead to your brain become clogged.
Peripheral Artery Disease (PAD) The blood vessels that carry blood to your arms and legs become clogged.
Diabetes Diabetes increases the severity of narrowing of the arteries.
High Levels of Homocysteine Elevated levels of homocysteine in your blood can cause your arteries to thicken and scar, making them more susceptible to clots.
Being Overweight A body mass index (BMI) of 25 or higher and a waist circumference greater than 35 inches in women or 40 inches in men increases TIA risk.
Smoking Smoking increases your risk of blood clots, raises your blood pressure, and contributes to the development of cholesterol-containing fatty deposits in your arteries.
Sedentary Lifestyle You can reduce your risk by getting 30 minutes of moderate-intensity exercise a day.
Poor Nutrition Eating too much fat and salt increases your risk of TIA and stroke.
Heavy Drinking Men should drink no more than two drinks daily and women should stick to one drink daily to reduce their risk of stroke.
Drug Use Cocaine and other illicit drugs should be avoided.
Birth Control Pills Taking certain hormone therapies may affect your risk of TIA and stroke.
TIA Symptoms
Symptoms of a transient ischemic attack (TIA) resemble those of a stroke, occur rapidly, and last for a few minutes.
- Weakness, numbness, or paralysis of the face, arms, or leg, especially on one side of your body
- Difficulty talking, slurred speech, or difficulty understanding others
- Difficulty seeing from one or both eyes or double vision
- Dizziness or loss of balance or coordination
- Trouble walking
- Confusion
- Severe headache (less common)
If you experience more than one TIA, you may experience similar or different symptoms, depending on which area of the brain is involved.
TIA Diagnosis
If you or someone you know experiences any of the above symptoms, seek medical treatment immediately.
Because a TIA is over quickly and most likely passed by the time you get medical care, your doctor may diagnose it based on your recall of the event rather than on anything found during a general physical and neurological exam.
To uncover the cause of your TIA and assess your risk of stroke, your doctor may perform the following:
Physical Exam During an exam, your doctor may order tests to check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes, and high levels of the amino acid homocysteine.
He or she may also use a stethoscope to detect plaque build-up in the arteries (atherosclerosis).
An eye exam may also allow your doctor to see cholesterol fragments or blood vessel abnormalities in your retina.
Carotid Ultrasonography In order to look for narrowing or clotting in your carotid arteries, a radiology technician can use a wand-like device to send high-frequency sound waves into your neck and deliver images on a screen.
Computerized Tomography (CT) Scanning CT scans can provide a 3D look at your brain.
Computerized Tomography Angiography (CTA) Scanning While CTA scanning uses X-rays similar to a standard CT scan, it may also include injecting a contrast material into a blood vessel.
Magnetic Resonance Imaging (MRI) By using a magnetic field, an MRI can generate a 3D view of your brain.
Magnetic Resonance Angiography (MRA) By using a strong magnetic field similar to MRI, this test evaluates the arteries in your neck and brain.
Echocardiography A transthoracic echocardiogram (TTE) allows a radiology technician to run an instrument across your chest that emits sound waves that echo off different parts of your heart, creating an ultrasound image.
Another procedure, a transesophageal echocardiogram (TEE), allows a probe to go through your esophagus.
Since the esophagus is behind your heart, your doctor may be able to get better images of blood clots, which might not be seen clearly in a TTE.
Arteriography By inserting a thin, flexible tube through a small incision (usually in your groin), a radiologist is able to see images of arteries in your brain that aren’t usually seen in X-rays.
TIA Treatment
Medication, surgery, and lifestyle changes may be needed to treat TIA.
Your doctor will determine the cause of the attack, and come up with a treatment to correct the abnormality and prevent a stroke.
Treatment may include medication, surgery, or a combination of both.
Medication
Your doctor will determine which medication to prescribe for you based on the location, cause, severity, and type of TIA you had. The following are two frequently prescribed types of drugs:
Anti-Platelet Drugs Platelets are one of the circulating blood cell types. When blood vessels are injured, sticky platelets begin to form clots.
Anti-platelet drugs work by making platelets less likely to stick together.
Aspirin is one of the most frequently used anti-platelet medications since it’s inexpensive and has few side effects.
Clopidogrel (Plavix) is an alternative to aspirin, while the drug Aggrenox is a combination of low-dose aspirin and another anti-platelet drug, dipyridamole.
Anticoagulants Rather than affecting platelet function, these drugs impact clotting-system proteins.
If you have an irregular heartbeat (also called atrial fibrillation), your doctor may prescribe an anticoagulant.
Heparin is an injectable anticoagulant drug used for a short time, while warfarin (Coumadin, Jantoven) is taken over a longer length of time.
You’ll be closely monitored if you take either of these medications.
Other anticoagulant drugs include:
Surgery
Your doctor may suggest one of the following surgeries or procedures to treat a TIA, depending on your condition:
Carotid Endarterectomy Your two carotid arteries supplies blood to your brain.
If you have carotid artery disease, meaning your carotid artery is moderately or severely narrowed, your doctor may suggest carotid endarterectomy.
This surgery clears the carotid arteries of fatty deposits in hopes of preventing further TIAs or strokes.
An incision is made to open the artery, the plaques are removed, and the artery is closed.
Angioplasty A less invasive treatment, angioplasty (also called stenting) is effective in some people who have a carotid artery blockage.
During the procedure, a balloon-like device is used to open a clogged artery, and then a small wire tube (called a stent) is placed into the artery to keep it open.
Lifestyle Modifications
The following lifestyle changes can help you prevent a TIA:
Control High Blood Pressure If your high blood pressure is uncontrolled, your risk of stroke increases.
Control Diabetes Diabetes increases the severity of narrowing of the arteries. You can manage diabetes and high blood pressure with diet, exercise, and weight control.
Eat Well Eating high cholesterol foods and foods high in saturated and trans fats can contribute to plaque build-up in your arteries.
Eating too much salt also increases your risk of TIA and stroke.
Additionally, fruits and vegetables contain nutrients such as potassium, folate, and antioxidants, which may protect against a TIA or a stroke.
Watch Your Weight A body mass index (BMI) of 25 or higher and a waist circumference greater than 35 inches in women or 40 inches in men increases risk of stroke.
Exercise You can reduce your risk of stroke by getting 30 minutes of moderate-intensity exercise a day.
Limit Alcohol Men should drink no more than two drinks daily and women should stick to one drink daily to reduce their risk of stroke.
Quit Smoking Smoking increases your risk of blood clots, raises your blood pressure, and contributes to the development of cholesterol-containing fatty deposits in your arteries.
Don’t Use Drugs Cocaine and other illicit drugs are associated with an increased risk of TIA and stroke.
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