Transient Ischemic Attack

ExitCare ImageA transient ischemic attack (TIA) is a "warning stroke" that causes stroke-like symptoms. Unlike a stroke, a TIA does not cause permanent damage to the brain. The symptoms of a TIA can happen very fast and do not last long. It is important to know the symptoms of a TIA and what to do. This can help prevent a major stroke or death.

CAUSES

  • A TIA is caused by a temporary blockage in an artery in the brain or neck (carotid artery). The blockage does not allow the brain to get the blood supply it needs and can cause different symptoms. The blockage can be caused by either:

  • A blood clot.

  • Fatty buildup (plaque) in a neck or brain artery.

RISK FACTORS

  • High blood pressure (hypertension).

  • High cholesterol.

  • Diabetes mellitus.

  • Heart disease.

  • The build up of plaque in the blood vessels (peripheral artery disease or atherosclerosis).

  • The build up of plaque in the blood vessels providing blood and oxygen to the brain (carotid artery stenosis).

  • An abnormal heart rhythm (atrial fibrillation).

  • Obesity.

  • Smoking.

  • Taking oral contraceptives (especially in combination with smoking).

  • Physical inactivity.

  • A diet high in fats, salt (sodium), and calories.

  • Alcohol use.

  • Use of illegal drugs (especially cocaine and methamphetamine).

  • Being male.

  • Being African American.

  • Being over the age of 55.

  • Family history of stroke.

  • Previous history of blood clots, stroke, TIA, or heart attack.

  • Sickle cell disease.

SYMPTOMS

TIA symptoms are the same as a stroke but are temporary. These symptoms usually develop suddenly, or may be newly present upon awakening from sleep:

  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • Sudden trouble walking or difficulty moving arms or legs.

  • Sudden confusion.

  • Sudden personality changes.

  • Trouble speaking (aphasia) or understanding.

  • Difficulty swallowing.

  • Sudden trouble seeing in one or both eyes.

  • Double vision.

  • Dizziness.

  • Loss of balance or coordination.

  • Sudden severe headache with no known cause.

  • Trouble reading or writing.

  • Loss of bowel or bladder control.

  • Loss of consciousness.

DIAGNOSIS

Your caregiver may be able to determine the presence or absence of a TIA based on your symptoms, history, and physical exam. Computed tomography (CT scan) of the brain is usually performed to help identify a TIA. Other tests may be done to diagnose a TIA. These tests may include:

  • Electrocardiography.

  • Continuous heart monitoring.

  • Echocardiography.

  • Carotid ultrasonography.

  • Magnetic resonance imaging (MRI).

  • A scan of the brain circulation.

  • Blood tests.

PREVENTION

The risk of a TIA can be decreased by appropriately treating high blood pressure, high cholesterol, diabetes, heart disease, and obesity and by quitting smoking, limiting alcohol, and staying physically active.

TREATMENT

Time is of the essence. Since the symptoms of TIA are the same as a stroke, it is important to seek treatment within 3–4½ hours of the start of symptoms because you may receive a medicine to dissolve the clot (thrombolytic) that cannot be given after that time. Treatment options vary. Treatment options may include rest, oxygen, intravenous (IV) fluids, and medicines to thin the blood (anticoagulants). Medicines and diet may be used to address diabetes, high blood pressure, and other risk factors. Measures will be taken to prevent short-term and long-term complications, including infection from breathing foreign material into the lungs (aspiration pneumonia), blood clots in the legs, and falls. Treatment options include procedures to either remove plaque in the carotid arteries or dilate carotid arteries that have narrowed due to plaque. Those procedures are:

  • Carotid endarterectomy.

  • Carotid angioplasty and stenting.

HOME CARE INSTRUCTIONS

  • Take all medicines prescribed by your caregiver. Follow the directions carefully. Medicines may be used to control risk factors for a stroke. Be sure you understand all your medicine instructions.

  • You may be told to take aspirin or the anticoagulant warfarin. Warfarin needs to be taken exactly as instructed.

  • Taking too much or too little warfarin is dangerous. Too much warfarin increases the risk of bleeding. Too little warfarin continues to allow the risk for blood clots. While taking warfarin, you will need to have regular blood tests to measure your blood clotting time. A PT blood test measures how long it takes for blood to clot. Your PT is used to calculate another value called an INR. Your PT and INR help your caregiver to adjust your dose of warfarin. The dose can change for many reasons. It is critically important that you take warfarin exactly as prescribed.

  • Many foods, especially foods high in vitamin K can interfere with warfarin and affect the PT and INR. Foods high in vitamin K include spinach, kale, broccoli, cabbage, collard and turnip greens, brussels sprouts, peas, cauliflower, seaweed, and parsley as well as beef and pork liver, green tea, and soybean oil. You should eat a consistent amount of foods high in vitamin K. Avoid major changes in your diet, or notify your caregiver before changing your diet. Arrange a visit with a dietitian to answer your questions.

  • Many medicines can interfere with warfarin and affect the PT and INR. You must tell your caregiver about any and all medicines you take, this includes all vitamins and supplements. Be especially cautious with aspirin and anti-inflammatory medicines. Do not take or discontinue any prescribed or over-the-counter medicine except on the advice of your caregiver or pharmacist.

  • Warfarin can have side effects, such as excessive bruising or bleeding. You will need to hold pressure over cuts for longer than usual. Your caregiver or pharmacist will discuss other potential side effects.

  • Avoid sports or activities that may cause injury or bleeding.

  • Be mindful when shaving, flossing your teeth, or handling sharp objects.

  • Alcohol can change the body's ability to handle warfarin. It is best to avoid alcoholic drinks or consume only very small amounts while taking warfarin. Notify your caregiver if you change your alcohol intake.

  • Notify your dentist or other caregivers before procedures.

  • Eat a diet that includes 5 or more servings of fruits and vegetables each day. This may reduce the risk of stroke. Certain diets may be prescribed to address high blood pressure, high cholesterol, diabetes, or obesity.

  • A low-sodium, low-saturated fat, low-trans fat, low-cholesterol diet is recommended to manage high blood pressure.

  • A low-saturated fat, low-trans fat, low-cholesterol, and high-fiber diet may control cholesterol levels.

  • A controlled-carbohydrate, controlled-sugar diet is recommended to manage diabetes.

  • A reduced-calorie, low-sodium, low-saturated fat, low-trans fat, low-cholesterol diet is recommended to manage obesity.

  • Maintain a healthy weight.

  • Stay physically active. It is recommended that you get at least 30 minutes of activity on most or all days.

  • Do not smoke.

  • Limit alcohol use even if you are not taking warfarin. Moderate alcohol use is considered to be:

  • No more than 2 drinks each day for men.

  • No more than 1 drink each day for nonpregnant women.

  • Stop drug abuse.

  • Home safety. A safe home environment is important to reduce the risk of falls. Your caregiver may arrange for specialists to evaluate your home. Having grab bars in the bedroom and bathroom is often important. Your caregiver may arrange for equipment to be used at home, such as raised toilets and a seat for the shower.

  • Follow all instructions for follow-up with your caregiver. This is very important. This includes any referrals and lab tests. Proper follow up can prevent a stroke or another TIA from occurring.

SEEK MEDICAL CARE IF:

  • You have personality changes.

  • You have difficulty swallowing.

  • You are seeing double.

  • You have dizziness.

  • You have a fever.

  • You have skin breakdown.

SEEK IMMEDIATE MEDICAL CARE IF:

Any of these symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in U.S.). Do not drive yourself to the hospital.

  • You have sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • You have sudden trouble walking or difficulty moving arms or legs.

  • You have sudden confusion.

  • You have trouble speaking (aphasia) or understanding.

  • You have sudden trouble seeing in one or both eyes.

  • You have a loss of balance or coordination.

  • You have a sudden, severe headache with no known cause.

  • You have new chest pain or an irregular heartbeat.

  • You have a partial or total loss of consciousness.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.