Health and Wellness
Five things you should know about transient ischemic attacks (TIA)
Often referred to as a "mini-stroke," a Transient Ischemic Attack (TIA) may actually be a warning sign for a future stroke. We asked Neurologist Chris Streib, MD, to tell us more.
- May 03, 2021
- By Staff Writer
But in about 12 percent of cases, there is a warning in the form of a transient ischemic attack, or TIA. Also known as a “mini-stroke,” a TIA is a temporary blockage of blood to the brain similar to a stroke. TIAs look like strokes in terms of signs and symptoms, but they are temporary. In other words, they leave no lasting brain damage or residual symptoms.
However, they serve as a warning sign that a person is at higher risk of a major stroke and should seek immediate medical attention. Strokes kill someone in the United States every four minutes, and stroke is a leading cause of long-term disability, according to the Centers for Disease Control and Prevention.
Like a stroke, a TIA occurs when a blockage in a blood vessel stops the flow of blood to part of the brain. Unlike a stroke, TIA symptoms do not persist and resolve within 24 hours – and often much faster. A TIA doesn’t leave any permanent brain damage or cause lasting neurologic problems. However, it does involve many of the same signs and symptoms as a stroke.
A person experiencing a TIA might feel sudden weakness or numbness on one side of the body, have slurred speech, have trouble seeing or talking, and feel confused. The person may experience a combination of these symptoms at the same time.
“The real takeaway? A TIA is an event that comes and goes without causing any permanent brain damage, but it is a critical warning sign,” Streib said.
Many people experiencing a TIA don’t seek medical attention right away—often because the symptoms may seem minor or because the person believes they will go away.
That’s dangerous, Streib said. At the time symptoms occur, a TIA and a stroke are difficult to tell apart. In both cases, it is critical that the victim receives rapid medical attention. The symptoms may appear harmless at first, but they may not resolve. In fact, they can worsen. For a stroke, quick medical care can minimize brain damage and reduce the risk of lasting impairments.
“The initial symptoms of stroke and TIA are indistinguishable. If you suspect that you or someone that you know is having a stroke or TIA, go to the hospital immediately, even if the symptoms are minor,” Streib said. “You cannot always accurately predict if a person will get better or worse and you want all treatment options readily available.”
A TIA is often referred to as a “mini-stroke,” but this name is misleading, according to Streib. TIAs may not be minor – symptoms can be quite severe even though they leave no permanent damage to the brain. Also, it’s important to recognize a TIA as a warning sign, because it often comes before a full stroke.
A person who experiences a TIA may have a 10-20 percent risk of having a full stroke in the next seven days depending on the cause, Streib said. The American Stroke Association confirms that 9 to 17 percent of people who have had a TIA have a stroke within 90 days. If they seek the proper care, patients can reduce that risk significantly.
“In some ways, people who have a TIA are actually very fortunate. It’s a warning that they are at high risk of a stroke that could cause permanent deficits,” Streib said. “They have a chance to make immediate lifestyle and medication change to reduce their risk of an actual stroke.”
To significantly reduce the risk of stroke, a person who has experienced a TIA must seek the proper follow-up care immediately after the episode.
Streib recommends that all patients visit an emergency room during or immediately after a TIA to receive imaging of their brain and blood vessels. These scans can inform patients and providers of the cause of their TIA and their immediate stroke risk. Scans also help them decide upon a treatment plan. Additionally, bleeding events in the brain can sometimes mimic TIA and require a completely different treatment.
When it comes to a TIA, seeking care at an emergency room is better than making an appointment with a primary care doctor, Streib said, because it can take much longer in the outpatient setting to order tests and interpret results. For some, that might be too late to prevent a subsequent stroke.
M Health Fairview is currently piloting a dedicated TIA clinic, where TIA patients undergo evaluation by the stroke team in the emergency department. If a TIA has been confirmed on evaluation and scans, many TIA patients can be discharged home for urgent clinic follow-up within 48 to 96 hours.
“Being discharged from the ED should not create a false sense of security around TIA,” Streib said. “The evaluation in the emergency department and follow-up testing are quite intensive. We review all the brain and blood vessel scans, optimize medications that thin the blood, reduce cholesterol, control blood pressure, and order all necessary outpatient testing before any TIA patient is cleared to leave.”
Patients who go home are seen in clinic within the next 48 to 96 hours to follow-up on their test results and further refine their medications. On the other hand, patients who are at high risk for a stroke stay in the hospital for additional medical or surgical treatment, such as removal of cholesterol-related blockages in the neck, a surgery known as carotid endarterectomy.
After a patient has received immediate medical attention following a TIA, Streib recommends working with a specialist to establish a long-term health plan to reduce the ongoing risk of a stroke – especially if the cause of the TIA remains unknown. Stroke specialists may use innovative treatment options and long-term testing methods.
“Patients need to see an expert,” Streib said. “Stroke prevention is based upon treating the patient’s specific underlying risk factors. Some of these risk factors are not readily apparent and may require diagnostic testing that takes months or longer. A stroke specialist is in the best position to identify the cause and help a patient take action to prevent a stroke.”