Transient Ischemic Attack
TIA, light stroke or mini-stroke|
- A Transient Ischemic attack (TIA) describes a sudden focal (localized to one part) deficit in brain functions that lasts less than 24 hours (i.e., Transient), while the symptoms are resolved after the Ischemic event.
- The type of symptoms depends on the location of the TIA.
- Numbness and weakness in one part of the body (face, arm, leg)
- Ataxia or problem with balance and walking
- Blindness or decrease in vision
- Double Vision
- Slurred speech
- Difficulty swallowing
- Difficulty with coordination of movements, such as using a pen to write.
- Neglecting a part of the body as if it does not exist
- Confusion and difficulty understanding others
- Brain ischemia
- A sudden, but brief interruption in the flow of oxygen rich blood to the brain will result in focal deficits such as visual problems, hemiplegia, weakness in one leg, speech disturbances, and falls.
- Atherosclerotic disease -- blood clots (Thrombus) are formed due to fatty plaques (See atherosclerosis) in the carotid arteries (the arteries that supply blood to the brain). These can break off into smaller pieces known as micro-emboli, which then travel (embolism) through the blood circulation of the carotids and it's branches to the brain, temporarily interrupting the blood flow to an area (a collection of nerve cells) that is responsible for a particular function in the body (e.g. moving the arms). This is the cause for the majority of cases of Strokes and TIAs.
- Emboli can also come from the heart. Blood clots in the heart can form secondary to mitral valve disease (e.g., mitral valve prolapse), after a heart attack (e.g., acute anterior wall infarction), arrythmias (e.g., atrial fibrillation), and in Congestive Heart Failure.
- Blood disorders such as sickle cell diseases and Polycythemia Vera can interrupt blood flow because of abnormal shape of red blood cells or increased number of blood cells respectively.
- Protein S deficiency, protein C deficiency, antiphospholipid antibodies, and Antithrombin 3 deficiency are all conditions associated with increased thickness of blood (hyper viscosity or hypercoagulable states).
- Autoimmune disorders (e.g. Systemic Lupus Erythematosus) infections (e.g. Syphilis) and vasculitis (e.g., polyarteritis) are rare causes of TIA.
- Patient with TIA is first stabilized and the diagnostic
work up is done
- If the patient is stable and symptoms have resolved, the
treatment and testing may be done on out patient basis.
- Once identified, the cause is corrected
- Medications to control arrythmias, heart failure, or Hypertension
- Surgery such as a Carotid endarterectomy is done if a
significant blockage (stenosis) is identified as the cause
of TIA or Stroke. A stenosis greater than 70%
- Ticlid or Enteric coded aspirin are often given to
reduce the risk of another Ischemic attack. Plavix and Persantine
are other medications that may be used alone or in combination with
others. All these medications increase the risk of
bleeding, so close monitoring after the medication is
started is recommended.
- Physical therapy and rehabilitation may be prescribed if
residual symptoms remain after a TIA.
- A clinical exam and history of
recent events and symptoms help in diagnosis.
- CAT scan or MRI of the brain can rule out bleeding (hemorrhage) rather than a clot inside the brain as the cause of the symptoms.
- Electrocardiogram and a 24 monitor (Holter monitor) can rule out any arrhythmias as the cause of the tia.
(Transthoracic and Transesophageal methods) can show the inside of the heart and see if there is a source of thrombus.
- Duplex Carotid Ultrasound is done to see the inside of the carotid arteries.
- Blood work includes Electrolytes, liver, and kidney functions. Complete blood count and differential, INR (measures bleeding potential) and may include specific antibodies tests.
- Angiography may also be done to evaluate blood flow in arteries.
- Family history
- Age -- Increases after age 45
- Males are at a greater risk than females
- Heart disease
- Oral contraceptives
- Control underlying disorders (e.g., Hypertension, diabetes, high cholesterol levels, heart disease etc.)
- It is time to stop smoking, starting exercising, and change to a healthier diet.
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