
Some people call a transient ischemic attack (TIA) a mini-stroke, because the symptoms are like those of a stroke but do not last long. A TIA happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage.
A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.
Symptoms of a TIA are the same as symptoms of a stroke. They may include:
A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. Once the clot dissolves, blood flow returns, and the symptoms go away.
Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a "low-flow" TIA. It is not as common as other types.
See a picture of a transient ischemic attack.
Your doctor will do tests to look at your heart and blood vessels. You may need:
Your doctor will also check to see if something else is causing your symptoms.
Your doctor will start you on medicines to help prevent a stroke. You may need to take several medicines.
If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may need surgery to open them up (carotid endarterectomy). This can help prevent blood clots that block blood flow to your brain. Another type of surgery is carotid artery stenting. During this surgery, the doctor puts a small tube called a stent inside your carotid artery. This helps keep the artery open. Carotid artery stenting is not as common as endarterectomy.
You can do a lot to reduce your chance of having another TIA or a stroke. Medicines can help, but you may need to make lifestyle changes too.
Frequently Asked Questions
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Blood clots that temporarily block blood flow to the brain are the most common cause of transient ischemic attacks (TIAs). Blood clots may develop for a variety of reasons.
Also, an artery that is partially blocked with plaque can reduce blood flow to the brain and cause symptoms.
Rare causes of blood clots that can cause a TIA include:
A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911. Early treatment can help prevent a stroke. If you think you had a TIA but your symptoms went away, you still need to call your doctor right away.
Symptoms of transient ischemic attacks (TIAs) occur suddenly and are always temporary. They usually go away within 10 to 20 minutes. TIA symptoms are just like stroke symptoms. They vary depending on which part of the brain is affected. Common symptoms of TIA may include:
Symptoms of a transient ischemic attack (TIA) usually go away within 10 to 20 minutes, but some can last longer. If symptoms last longer than an hour, it might be more likely that you have had a stroke.
TIA symptoms, which are caused by a blood clot that temporarily reduces blood flow to the brain, disappear when the blood clot dissolves and blood flow returns.
A TIA is a warning sign that a stroke may soon follow. Any symptoms of a TIA need to be treated as an emergency.
A TIA also may signal an increased risk for a heart attack. Atherosclerosis, which is hardening of the arteries, affects blood vessels throughout the body, including arteries that supply blood to the heart and brain. Atherosclerosis that affects the blood vessels in the heart (coronary arteries) may cause chest pain or a heart attack.
The risk factors for a transient ischemic attack (TIA) are the same as those for a stroke.
Risk factors for TIA that you can change are:
Risk factors for TIA that you cannot change are:
Your risk for TIA increases if you have diseases such as:
Call 911 or other emergency services immediately if you have:
Call your doctor immediately if you have:
Call your doctor today if you think you have had a TIA in the past and have not yet talked with your doctor about your symptoms.
Taking a wait-and-see approach, called watchful waiting, is not appropriate if you are having symptoms of a TIA. Any symptoms of a TIA need to be considered a medical emergency. Seek medical assistance immediately.
The following doctors can diagnose and treat a transient ischemic attack (TIA):
Other specialist(s) may be consulted if you need surgery or have other health problems:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Immediate evaluation is recommended if you have had or are having a transient ischemic attack (TIA). The purpose of evaluation is to:
If your TIA symptoms have completely disappeared, the results of a physical exam will be normal, and the diagnosis of a TIA usually will be based on your medical history and certain tests.
If a TIA is suspected, the doctor may want to do tests, such as a:
Further tests are often done to identify the cause of the TIA. If blockage of the carotid arteries is suspected, you may have tests such as:
TIA symptoms may be due to blood clots caused by a heart problem. If heart problems are suspected, you may have tests such as a:
You may have other blood tests, such as a complete blood count (CBC), chemistry screen, and prothrombin time based on your age and medical history. Your doctor will use these tests to look for other causes of the TIA.
If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. Also, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.
If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If you had symptoms of a TIA but you feel better now, you still need to see a doctor right away. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. After a TIA, 3 to 17 out of 100 people will have a stroke within 90 days. The risk of stroke is highest in the first 30 days after a TIA. And of the people who have a stroke after a TIA, half have a stroke less than 48 hours after the TIA.1
You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.
If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). For more information about this surgery, see:
Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:
You may also need to make lifestyle changes such as:
If you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to get regular blood tests and watch how much vitamin K you eat or drink. For more information about safety with warfarin, see:
If you have more than one transient ischemic attack (TIA) close together (a cluster of TIAs), you may be hospitalized because of the increased risk for stroke.
Emergency treatment for stroke is most effective when it is given right away after symptoms begin.
For more information, see the topic Stroke.
After you have an initial evaluation for a TIA, you may need further testing and treatment on an outpatient basis. But because of the increased risk of stroke, staying in the hospital may be recommended for:
You can help prevent a transient ischemic attack (TIA) by controlling your risk factors for stroke.
Because atrial fibrillation increases your risk of stroke and because many people do not have symptoms of atrial fibrillation, the National Stroke Association recommends that everyone, particularly those age 55 or older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse. If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.
If you are age 55 or older and have atrial fibrillation, you can check your risk of stroke by using the Interactive Tool: Stroke Risk From Atrial Fibrillation.
Home treatment is not appropriate for a transient ischemic attack (TIA). If you think you are having a TIA, do not ignore the symptoms and do not try to manage them at home. If you had symptoms of a TIA but they went away, you still need to see a doctor right away. Seek emergency medical care when symptoms first appear. Prompt treatment may keep you from having a stroke.
If you have had a TIA recently:
Your doctor will probably prescribe several medicines after you have had a transient ischemic attack (TIA). Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.
The types of medicines that prevent clotting are:
Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent TIAs and strokes.
Antiplatelets (such as aspirin, aspirin with extended-release dipyridamole, or clopidogrel) keep platelets in the blood from sticking together.
Anticoagulant medicines, also called blood thinners, prevent blood clots from forming and keep existing blood clots from getting bigger. If you have atrial fibrillation, you will probably take an anticoagulant such as warfarin (for example, Coumadin). For more information, see the topic Atrial Fibrillation.
Statins lower cholesterol and can greatly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.2
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgical procedure, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA and how much your carotid arteries have narrowed.
You are most likely to benefit from surgery if you have had a TIA in the past 6 months and you have 70% or greater narrowing in one of your carotid arteries. Carotid endarterectomy may also be appropriate if your carotid arteries are moderately or severely blocked (50% to 70%) and you have had one or more TIAs.5 Talk to your doctor about whether a carotid endarterectomy is right for you.
Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
Carotid endarterectomies are most successful when they are done by a surgeon who is well trained in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure.
If you are considering carotid endarterectomy, ask the hospital or state medical board about the number of times complications have occurred in people that your doctor has treated with this surgery and the complication rate at the hospital where the surgery is to be done. The American Heart Association Stroke Council recommends that surgery be done by a surgeon who has complications in less than 3% of those treated and that the hospital rate of complications be just as low.5
Carotid endarterectomy is often not done until several months after a TIA, but a large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because a person is more likely to have a stroke in the first few days and weeks after a TIA. These results also point out why it is so important to see a doctor immediately if you have any signs of TIA.6
Carotid artery stenting is a procedure similar to one commonly used to open narrowed arteries in the heart. Angioplasty combined with a stent is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.
| National Institute of Neurological Disorders and Stroke | |
| P.O. Box 5801 | |
| Bethesda, MD 20824 | |
| Phone: | 1-800-352-9424 (301) 496-5751 |
| TDD: | (301) 468-5981 |
| Web Address: | www.ninds.nih.gov |
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders. | |
| American Heart Association (AHA) | |
| 7272 Greenville Avenue | |
| Dallas, TX 75231 | |
| Phone: | 1-800-AHA-USA1 (1-800-242-8721) |
| Web Address: | www.heart.org |
Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support. | |
| National Heart, Lung, and Blood Institute (NHLBI) | |
| P.O. Box 30105 | |
| Bethesda, MD 20824-0105 | |
| Phone: | (301) 592-8573 |
| Fax: | (240) 629-3246 |
| TDD: | (240) 629-3255 |
| Email: | nhlbiinfo@nhlbi.nih.gov |
| Web Address: | www.nhlbi.nih.gov |
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
| |
| National Stroke Association | |
| 9707 East Easter Lane, Building B | |
| Centennial, CO 80112 | |
| Phone: | 1-800-STROKES (1-800-787-6537) |
| Fax: | (303) 649-1328 |
| Email: | info@stroke.org |
| Web Address: | www.stroke.org |
This association provides education, information, referrals, and research on stroke. | |
Citations
- Lloyd-Jones D, et al. (2009). Heart disease and stroke statistics 2010 update: A report from the American Heart Association. Circulation. Published online December 17, 2009 (doi: 10.1161/circulationaha.109.192667). Also available online: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192667.
- Adams RJ (2008). AHA/ASA science advisory: Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 39(5): 1647–1652.
- Kasner SE, Morgenstern LB (2004) Cerebrovascular disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 4. New York: WebMD.
- ESPRIT Study Group (2006). Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): A randomized controlled trial. Lancet, 367(9523): 1665–1673.
- Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.
- Rothwell PM, et al., (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363(9413): 915–924.
Other Works Consulted
- Easton JD, et al. (2009). Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke, 40(6): 2276–2293. Also available online: http://stroke.ahajournals.org/cgi/reprint/40/6/2276.
- Goldstein LB, et al. (2006). Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council. Stroke, 37(6): 1583–1633.
- Rothwell PM, et al. (2007). Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): A prospective population-based sequential comparison. Lancet, 370(9596): 1432–1442.
- Sacco RL, et al. (2006). Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke, 37(2): 577–617.
- Skinner JS, Cooper A (2009). Secondary prevention of ischaemic cardiac events, search date October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Smith SC, et al. (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: Endorsed by the National Heart, Lung, and Blood Institute. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation |
| Last Revised | January 31, 2011 |
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