Louise D. McCullough, MD, PhD
Louise D. McCullough, MD, PhD professor, and Huffington chair of the department of neurology at UTHealth Houston, and chief of neurology at Memorial Hermann Hospital at the Texas Medical Center.
A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain. To dismiss it as a mini-stroke, as it’s often referred to, is a big mistake. “Mini-stroke” implies that a TIA is not dangerous when, in fact, it can be a warning that a full-blown stroke is ahead.
A TIA is a short-lived reaction to a clot or other form of blockage in the brain. It’s considered temporary because the clot either dissolves or dislodges on its own. (With a full-blown stroke, on the other hand, emergency clot-dissolving medication is often needed.)
An underlying TIA trigger is often the buildup of plaque along the walls of an artery or artery branch that feeds the brain. Plaque slows the nutrient-rich flow of blood to the brain and can itself cause a clot.
Though people associate strokes with older age, a TIA can happen to anyone, and they’re occurring in younger and middle-aged adults more frequently than in the past.
A TIA is particularly concerning because it is often a warning sign, sounding the alarm for additional TIAs, a full-blown stroke, or other cardiovascular problems to come. About 15 percent of all strokes are preceded by a TIA.
Looked at another way, close to one-third of people who experience a TIA will have a stroke within the following year. That means taking immediate steps to reduce stroke risk is vital.
The symptoms of a TIA are the same as a full stroke and include double vision or loss of vision in one or both eyes, slurred speech, unsteadiness, and sudden changes on one side of the body, from numbness or weakness to paralysis.
On average, the symptoms of a TIA last for less than five minutes, but they can go on for longer. A sudden severe headache can be a sign of bleeding within or around the brain, most commonly linked to high blood pressure or an aneurysm. The symptoms usually do not go away. Getting to the hospital is just as important, especially if symptoms like weakness or vision changes are present.
If you or someone with you experiences any of these symptoms, get help immediately—even if the symptoms go away. Check the time as you call 911 so you’ll be able to tell the EMTs and doctors in the emergency room when the symptoms first appeared.
Also, bring a list of your medications with you. This is important because certain medications are needed right away, and some medications like blood thinners may be dangerous in that setting.
An immediate medical workup is needed to determine whether you had a TIA, a more significant stroke, or something entirely different, such as a complex migraine or a seizure. Some strokes that seem to be TIAs are not.
Doctors will try to determine where the blockage originated and whether damage was done to the brain, the determining factor in whether this was a TIA or a more serious stroke. A workup is likely to include blood tests and one or more imaging tests, such as a CT scan or MRI. A TIA may involve other tests in younger people.
A TIA, by definition, means that you will completely return to your baseline condition in 24 hours. No damage will be seen on imaging tests. With a true TIA, your body was probably able to restore blood flow to the brain before any anatomical changes or damage could occur. It’s important for your doctors to determine what might have led to the TIA to prevent another one or a larger stroke.
Even though your symptoms may go away, damage can sometimes be seen on imaging tests, especially on an MRI. If that occurs, you have had a stroke. It’s important to know what type of stroke you had and where it came from so you can prevent a larger one that does lead to permanent symptoms. Even a small stroke can cause ongoing issues, including gait and memory problems.
Your doctor may perform an echocardiogram on your heart to look for clots. If an irregular heart rhythm, such as atrial fibrillation, is suspected, you may need a temporary implantable monitor placed under your skin to look for it. Recent studies suggest that wearing an external 30-day portable monitor often misses atrial fibrillation, which takes closer to 80 days to detect. You might benefit from treatment with an anticoagulant drug like apixaban (Eliquis) or coumadin (Warfarin), which can reduce the risk of a stroke by 60 to 80 percent.
You might undergo a carotid ultrasound or cerebral angiogram to look for a blockage in the carotid artery in your neck. For a minor blockage, antiplatelets like aspirin and statins may be prescribed or, if there’s more than 70 percent blockage, you may need a procedure to correct it.
Doctors may perform a CT angiogram to see how the blood vessels supplying your brain look. If you have plaque in the arteries within the brain, they may have caused a stroke in one of the smaller vessels (called a lacunar stroke). These will show up on MRI. You might be prescribed an antiplatelet drug, such as clopidogrel (Plavix) or aspirin as part of a management strategy.
Most TIAs (and strokes) can be prevented by managing risk factors that are within your control:
