- A transient ischaemic attack (TIA) happens when the blood supply to your brain is blocked temporarily. The signs are the same as for a stroke, but they disappear within a short time. Often, they are only present for a few minutes.
- After a suspected TIA, your doctor will do tests to provide a diagnosis and decide what treatment you need.
- You must not drive for two weeks after a TIA. If you have a commercial driving licence, you must not drive for four weeks.
- After a TIA, your risk of stroke is higher. Stroke can lead to death or disability. A TIA is a warning that you may have a stroke and is an opportunity to act to prevent this happening. With investigation and treatment, the risk of stroke following a TIA can be reduced by up to 80 percent.
- A TIA should never be ignored. Call 000 immediately if you think you may be having a TIA, even if the signs go away and you feel better.
What is a TIA?
Blood is carried to your brain by blood vessels called arteries. Blood carries oxygen and nutrients for your brain cells. If the blood supply to your brain is blocked, your brain cells will die.
A transient ischaemic attack happens when the blood supply to your brain is blocked temporarily. When the blood supply is stopped, the brain cells in the area start dying, and you experience signs that something is wrong.
If the blockage clears and the blood supply starts again, the brain gets the oxygen and nutrients it needs and the signs disappear. This makes a TIA different to a stroke, where the brain cells die and your brain is permanently damaged.
Transient ischaemic [is-key-mick] attack is often shortened to ‘TIA’.
After a TIA, your risk of stroke is higher. Stroke can lead to death or disability. A TIA is a warning that you may have a stroke and an opportunity to prevent this from happening.
Signs
A TIA should never be ignored. The risk of stroke is highest in the first few hours and days after a TIA. You should call 000 immediately even if the signs go away and you feel better.
The FAST test is an easy way to remember the most common signs of stroke and TIA.
The signs are the same as for a stroke, but they completely disappear within a short time. Often, they are only often present for a few minutes.
The signs can be different for different people, depending on which part of the brain is affected.
There can be other signs, such as:
- Numbness, clumsiness, weakness or paralysis of the face, arm or leg on one or both sides.
- Dizziness (in particular ‘head spins’), loss of balance or an unexplained fall.
- Loss of vision in one or both eyes.
- Headache, usually severe and sudden.
- Difficulty swallowing.
- Nausea or vomiting.
It is important to make your family and friends aware of the signs of stroke and the need to call 000 immediately.
Tests
Your doctor will want to know about your signs – what they were, how long they lasted and whether you have had them before. This will help distinguish between a TIA and other possible causes.
Your doctor will do a series of tests. These vary from person to person and may include:
Brain scans
Computerised tomography (CT scan) or magnetic resonance imaging (MRI) take detailed pictures of your brain. After a suspected TIA, everyone should have a brain scan.
A brain scan is used to decide if you have had a TIA, a small stroke (with no ongoing impacts) or something that ‘mimics’ a TIA. There are other conditions that mimic TIA, so expert review is needed to distinguish TIAs from these other conditions.
If you have had a TIA, your scan will not show any signs of recent brain injury.
Imaging of the arteries
Arteries carry blood from the heart to the brain. Tests can see how the blood flows through the arteries, as damaged or blocked arteries in the neck can cause TIA. This is done in a variety of ways including ultrasound, CT angiogram or magnetic resonance angiogram.
Blood pressure check
After an initial check of your blood pressure, you may need it measured regularly.
Heart tests
An electrocardiogram (ECG) tests for abnormal heart rhythm. Everyone suspected of having had a TIA should have an ECG. Atrial fibrillation (AF) is a heart condition in which your heart beats out of rhythm. Atrial fibrillation increases your risk of stroke, so testing for atrial fibrillation is very important after a TIA.
You may also need to wear a Holter monitor for 24 hours or longer. This checks your heart rhythm over an extended period of time. Your doctor may also order an echocardiogram (cardiac echo or ECHO) which is an ultrasound test that looks at the structures of the heart, as well blood flow within the heart.
Blood tests
These tests are used to check your health. Blood tests can cover:
- Cholesterol (fasting lipids)
- Blood sugar levels
- How well your kidneys work
- The way your blood clots
Your doctor will discuss your test results with you so you have a better understanding of what has happened and what you need to do. Your doctor will make a plan for follow up, including referrals and appointments. You may need to go back to the hospital for further tests. Your doctor may refer you to a specialist. It is important to go to these appointments, even if you are feeling better.
Driving
You must not drive for two weeks after a TIA. If you have a commercial driving licence, you must not drive for four weeks.
If you drive before this time, you might be criminally liable if you have an accident. Also, your insurance may not cover you. If you are unsure, check with your doctor and with the licensing authority in your state.
The rules about driving are different for different medical conditions, which means it is important to have it confirmed by your doctor that you have had a TIA.
For more information contact your State licensing authority.
Download
Download this resource Transient ischaemic attack – Signs, treatment and reducing your risk (PDF 2.55 MB)
TIA symptoms are similar to stroke symptoms but do not last as long and result in no permanent brain injury. TIAs should be considered a warning of the likelihood of a coming stroke.
A stroke happens when the blood supply to the brain is interrupted. This can happen when a blood vessel in the brain bursts (hemorrhagic stroke), or when there is some type of blockage that cuts off blood supply (ischemic stroke). When brain cells are deprived of oxygen, they die.
What is a transient ischemic attack (TIA)?
A transient ischemic attack (TIA), also sometimes referred to as a “mini-stroke,” starts like a stroke but only lasts from several minutes up to 24 hours. Unlike a stroke, a TIA does not kill the brain cells, so there is no lasting damage to the brain. However, when a TIA begins, there is no way to tell if a person is having a stroke or a TIA.
Approximately 240,000 adults in the United States experiences a TIA each year. At least another 690,000 adults experience an ischemic stroke. Approximately 15 percent of all patients who have experienced a stroke have had a previous TIA. Patients with TIAs are at a particularly increased risk of having a stroke within the following days to weeks. TIAs should be considered warning signs of potential future strokes.
What are the risk factors for a transient ischemic attack (TIA) or stroke?
Some factors cannot be modified (such as age), while others can (smoking). Risks of TIA and stroke include:
- Older age. The risk of stroke doubles with each decade after age 55 in both men and women.
- Family history of stroke
- Male sex. Men have a higher risk of TIA; women have a higher lifetime risk of stroke.
- Race or ethnicity. African Americans and people of Hispanic ethnicity are at higher risk of TIA and stroke than Caucasian (white) people.
- High blood pressure (hypertension)
- Physical inactivity
- Diabetes
- Heart disease
- Atrial fibrillation
- Smoking (both tobacco and marijuana)
- High blood cholesterol levels
- Drug abuse
- Obesity
The symptoms of a transient ischemic attack (TIA) and a stroke do not differ. Symptoms generally come on suddenly and can include:
- Difficulty seeing from one or both eyes
- Numbness or weakness in the face, arms, or legs, especially on one side
- Severe headache
- Difficulty walking
- Dizziness, loss of coordination and balance
- Difficulty speaking or understanding words
If stroke or TIA symptoms appear, it is very important to go to the ER to get immediate medical help, even if symptoms resolve!
Patients who experience a TIA should be seen by medical providers immediately. Evaluation includes examination by a doctor and diagnostic testing. The doctor will do some simple quick checks to test your vision, muscle strength, and ability to think and speak. Diagnostic testing consists of either a computed tomogram (CT) or magnetic resonance imaging (MRI) scan of the brain and carotid arteries to determine the possible cause of the TIA. Other tests include an electrocardiogram (ECG) of the heart, heart rate, body temperature, sleep study (to look for sleep apnea) and blood work (to look for risk factors for stroke – see above -- that can be treated).
Acute Stroke Treatments
Because transient ischemic attacks (TIAs) are considered to be “mini strokes,” the general approach to treating and preventing TIAs is the same as that used to treat and prevent strokes.
Drug treatments based on specific medical findings include:
- If your recent stroke or TIA (within 30 days) was caused by severe narrowing of a major artery in the brain, your doctor may recommend you take the aspirin and clopidogrel (Plavix®) for 90 days.
- If you have an irregular heartbeat (atrial fibrillation), your doctor may recommend treatment with an anticoagulant drug such as warfarin (Coumadin®), apixaban (Eliquis®), rivaroxaban, (Xarelto®), or dabigatran (Pradaxa®).
If atherosclerosis (fatty deposits/“plaques”) are found in the carotid arteries -- the artery that supplies blood to the brain, carotid surgery may be recommended. One of two surgical approaches might be recommended:
- Carotid endarterectomy — surgical removal of the plaque within the carotid artery.
- Carotid angioplasty and stenting procedure —a less invasive alternative treatment appropriate for some patients who have a carotid artery blockage. The procedure involves flattening the build up of fatty plaque or blockage against the walls of the artery, which then allows increased blood flow. The stent (a small, metal mesh tube) remains in place as a permanent scaffold to keep the artery open.
To reduce the risk of a future TIAs or strokes, follow these tips:
- If you smoke, stop.
- Monitor your blood pressure and follow your doctor’s treatment plan if your blood pressure is high. The target blood pressure is less than 140/90 mm Hg for all adults who have a history of TIA or stroke. Choice of drug therapy depends on many patient specific considerations.
- Monitor your cholesterol and follow your doctor’s treatment plan if your cholesterol level is high. The target low density liproprotein (LDL) level is less than 100 mg/dl in patients with atherosclerotic stroke or TIA and lower than 70 mg/dl in patients who also have diabetes. Statin drugs are the drugs of choice if drug therapy is recommended.
- Eat a Mediterranean-style diet (a diet high in vegetables, fruits, whole grains, fish, legumes, poultry, olive oil, nuts, and low-fat dairy products). Limit your intake of red meat and sweets. Reduce your salt (sodium) intake to less than 2.4 g/day.
- Maintain a healthy weight.
- Stop drinking alcohol, except in moderation (up to two drinks per day for men and up to 1 drink per day for nonpregnant women).
- Exercise. Engage in three to four, 40-minute sessions of moderate to intense aerobic exercise per week. Moderate to intense exercise means the activity causes you to break a sweat or noticeably raise your heart rate. Examples include a brisk walk or using an exercise bike.
- Wear your CPAP (Continuous Positive Airway Pressure) device if you have been diagnosed with sleep apnea and your doctor recommended use of this device.
Last reviewed by a Cleveland Clinic medical professional on 07/26/2018.
References
- American Heart Association/American Stroke Association. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke (//www.ahajournals.org/doi/10.1161/STR.0000000000000158) : A Guidelines for Healthcare Professionals. Stroke 2018;49:e46-e99.
- American Stroke Association. Transient Ischemic Attack. (//www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/Transient-Ischemic-Attack-TIA_UCM_492003_SubHomePage.jsp) Accessed 11/18/2021.
- National Institute of Neurological Disorders and Stroke. NINDS Information Page:Transient Ischemic Attacks. (//www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page) Accessed 11/18/2021.
- National Stroke Association. Transient Ischemic Attack: What is TIA? (//www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack) Accessed 11/18/2021.
- Sonni S, Thaler DE. Transient ischemic attack: Omen and opportunity. (//www.ccjm.org/content/80/9/566) CCJM 2013 September; 80(9):566-576.
- Henderson GV. Chapter 210. Transient Ischemic Attack and Stroke. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York, NY: McGraw-Hill; 2012.
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