What Is a Transient Ischemic Attack (TIA)?

A transient ischemic attack (TIA), also called a mini-stroke, is a temporary loss of normal neurological function caused by a brief interruption of blood flow to part of the brain. The symptoms of a TIA require immediate medical attention and are the same as those of a stroke. They may include weakness or numbness in the face, hand, arm, or leg, vision changes, and/or slurred speech, to name a few.

TIA Symptoms 

The precise symptoms of a TIA vary tremendously from person to person and depend on which part and how much of the brain is being deprived of blood flow.

Some of the typical symptoms of TIA include:

• Weakness in the hand, arm, leg, face, tongue, or face
• Numbness in the hand, arm, leg, face, tongue, or face
• Inability to speak coherently
• Unexplained dizziness, often with vertigo (the sensation that the room is spinning)
• Double vision, partial loss of vision, or other sudden visual disturbances
• Severe headache with no apparent cause

How It Compares to a Full Stroke

The symptoms of a TIA are identical to the symptoms of a stroke. A TIA is only distinguishable from a stroke when the symptoms resolve by themselves. Until that moment, for all practical purposes, you are having a stroke and will be treated as such by your medical team.

Causes

TIAs are caused by the same disease processes that produce stroke—blockage of the arteries to the brain from a blood clot, mostly due to atherosclerosis (fatty buildup in an artery) or embolism (when a blood clot travels from somewhere else in the body, like the heart, to the brain).

With stroke, the blockage persists long enough to produce the death of brain tissue. With a TIA, on the other hand, the blockage is transient and the brain tissue recovers once the blockage improves.

TIAs are, therefore, analogous to unstable angina, a condition in which transient blockages in the coronary arteries produce chest pain. And just as unstable angina often heralds a full myocardial infarction (heart attack), the occurrence of a TIA indicates that a full stroke is likely to occur.

There are several factors that increase a person's risk for developing a TIA (and a stroke).

Some of these factors include:

• Hypertension (high blood pressure)
• Hyperlipidemia (high cholesterol)
• Smoking
• Diabetes
• Atrial fibrillation
• Heavy alcohol consumption
• Poor diet (one that is high in saturated/trans fats and/or salt)
• Physical inactivity
• Certain genetic conditions (e.g., sickle cell anemia)

Diagnosis

Diagnosis of a TIA requires a careful medical history and neurological exam, as well as imaging of the brain and the large blood vessels that supply the brain. Heart testing and various blood tests may also be ordered.

Medical History

During the medical history, a healthcare provider will ask questions regarding symptom specifics, such as:

• Whether the symptoms are focal (weakness or numbness on one side of the body) or nonfocal (e.g., generalized weakness or light-headedness)
• Whether the symptoms came on suddenly or gradually
• If the symptoms have occurred before

Questions like these can help sort out whether alternative health conditions need to be considered in more depth, like migraine, multiple sclerosis, or a seizure disorder.

Physical Examination

The physical examination will include a measurement of the vital signs (e.g., systolic and diastolic blood pressure), a heart exam, and a complete neurological exam (e.g., checking reflexes, strength, and a cranial nerve exam).

Imaging

If your healthcare provider thinks you have had a TIA, various imaging tests will be performed, which are aimed at identifying the precise cause of the event. Brain imaging is also used to rule out conditions that may mimic a TIA.

Imaging tests that may be ordered during the workup of a TIA include:

• Brain imaging with computed tomography (CT) or magnetic resonance imaging (MRI) scanning
• Imaging of the major blood vessels that supply the brain, either with a carotid ultrasound, CT angiogram, or MRI angiogram
• Heart testing with an electrocardiogram (ECG) and sometimes more extensive cardiac rhythm monitoring (e.g., telemetry in the hospital or Holter monitor). Echocardiography, to look for a source of blood clots that could embolize to the brain, may also be performed.

Blood Tests

Blood tests are utilized to not only rule out conditions that mimic TIA but to also access a person's risk for developing a recurrent TIA or stroke.

Examples of such tests include:

• Fasting blood glucose (sugar) level
• Blood electrolyte levels
• Complete blood count (CBC)
• Coagulation studies
• Fasting lipid panel

Treatment

Once an evaluation for a TIA is complete, the treatment your healthcare provider recommends will depend largely on what has been found.

The main goal of treating a person who has had a TIA is to prevent a future stroke. Any of the following may be considered.

Managing Risk Factors

Aggressively treating the risk factors that produce atherosclerosis can prevent the re-occurrence of a TIA or more seriously, a future stroke.

Strategies include:

• Adopting a healthy diet
• Exercising regularly
• Medications to improve hypertension and high cholesterol
• Medications to gain excellent control of diabetes
• Smoking cessation

Drug Therapies

Antiplatelet therapy with aspirin, aspirin plus dipyridamole, or Plavix (clopidogrel) is used to inhibit the formation of abnormal clots within the arteries.

Anticoagulation therapy, such as with Eliquis (apixaban) or Coumadin (warfarin), is used to treat certain health conditions that promote blood clot formation, like atrial fibrillation.

Procedures

Your healthcare provider may recommend restoring blood flow to the carotid artery (located in your neck) through a process called revascularization. Specifically, a carotid endarterectomy may be performed to surgically open and repair the artery if a significant blockage is found.

Stenting of the carotid artery (propping the artery open to improve blood flow), is another option, depending on certain patient characteristics.

A Word From Verywell

Even though the symptoms resolve on their own, a TIA is a very serious medical problem. By seeking immediate medical care after a TIA, you can greatly reduce your odds of having a full stroke.

If you have been treated for a TIA or stroke, focus your energy on preventing the next one, which you have the power to do. Take your prescribed medications, eat healthfully, exercise regularly, and eliminate habits like smoking or excessive alcohol intake.