Transient Ischemic Attack (TIA)
Content of This Page
1- Introduction
2- Causes
3- Symptoms
4- Investigations & Lab Results
5- Complications
6- Treatment
Introduction
A Transient Ischemic Attack (TIA) is a brief episode of neurological dysfunction caused by a temporary interruption of blood flow to the brain, spinal cord, or retina. Unlike a full stroke, the symptoms of a TIA resolve completely within 24 hours, often lasting only a few minutes, and do not result in permanent brain damage. Despite its transient nature, a TIA serves as an important warning sign, indicating a significantly increased risk of a future stroke. Early recognition and timely medical evaluation are crucial to prevent subsequent, potentially more severe strokes.
Causes
Atherosclerosis causing narrowing of cerebral arteries
Emboli from the heart or large arteries (e.g., due to atrial fibrillation, heart valve disease)
Small vessel disease (lacunar infarcts)
Arterial dissection (tear in the artery wall)
Hypercoagulable states (blood clotting disorders)
Hypotension or low blood flow states
Rare causes: vasculitis, migraine, or hematologic disorders
Symptoms
Sudden weakness or numbness on one side of the body (face, arm, or leg)
Sudden difficulty speaking or understanding speech (aphasia)
Sudden vision changes (loss of vision in one or both eyes, double vision)
Sudden dizziness, loss of balance, or coordination problems
Sudden severe headache (less common)
Sudden confusion or difficulty swallowing (less common)
Investigations & Lab Results
1. Brain Imaging
MRI with Diffusion-Weighted Imaging (DWI):
Preferred to detect recent ischemic changes, even if symptoms resolve.
CT Scan (Non-contrast):
Often done initially to exclude hemorrhage or other causes.
2. Vascular Imaging
Carotid Doppler Ultrasound:
To detect carotid artery stenosis or plaques.
CT Angiography (CTA) or MR Angiography (MRA):
Detailed imaging of cerebral and neck vessels to find occlusions or narrowing.
3. Cardiac Evaluation
Electrocardiogram (ECG):
To identify arrhythmias, especially atrial fibrillation.
Echocardiography:
To detect cardiac sources of emboli like thrombi or valvular abnormalities.
Holter Monitoring (24–72 hours):
For intermittent arrhythmias not detected on ECG.
4. Laboratory Tests
Complete Blood Count (CBC):
To check for anemia, infection, or other blood disorders.
Blood Glucose:
To rule out hypo- or hyperglycemia.
Lipid Profile:
To assess cholesterol levels.
Coagulation Profile (PT/INR, aPTT):
Important if anticoagulation is considered.
Renal Function Tests:
To evaluate kidney function before starting medications.
Additional Tests (if indicated):
Inflammatory markers, thrombophilia screening, autoimmune panels depending on clinical suspicion.
Complications
Increased risk of full stroke: About one-third of patients with a TIA will have a major stroke, often within days to weeks after the event.
Recurrent TIAs: Multiple transient attacks can occur, increasing cumulative brain injury risk.
Permanent neurological damage: Although rare, some TIAs may cause small areas of brain injury detectable on imaging.
Psychological impact: Anxiety and fear of stroke recurrence are common in patients after a TIA.
Disability and reduced quality of life: Due to recurrent events or stroke development if untreated.
Treatment
1. Immediate Management
Urgent evaluation: TIA is a medical emergency; patients need prompt assessment to reduce stroke risk.
Hospital admission or urgent outpatient workup depending on risk factors and timing.
2. Medical Treatment
Antiplatelet therapy:
Aspirin is usually started immediately to reduce clot formation.
In some cases, dual antiplatelet therapy (aspirin + clopidogrel) may be given short-term.
Anticoagulation:
For patients with atrial fibrillation or other cardiac sources of emboli, anticoagulants (e.g., warfarin or DOACs) are indicated.
Control of vascular risk factors:
Hypertension management
Blood sugar control (diabetes)
Statins to lower cholesterol
Lifestyle modification:
Smoking cessation
Healthy diet and regular exercise
Weight management
Limiting alcohol intake
3. Surgical/Interventional Treatment
Carotid endarterectomy or stenting:
Recommended for significant carotid artery stenosis (>70%) to prevent stroke.
4. Follow-up and Rehabilitation
Regular monitoring of risk factors and adherence to treatment.
Education about recognizing stroke symptoms for early intervention.