Transient ischaemic attack

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who have had a transient ischaemic attack (TIA), or who would like information about it.

A TIA is a temporary disruption in the blood supply to the brain. It causes symptoms similar to stroke and is sometimes referred to as a mini stroke.

About transient ischaemic attack

In a TIA, the blood supply to your brain becomes blocked for a short time, temporarily starving it of oxygen and nutrients. Your brain controls everything your body does, including your movement, speech, vision and emotions. So disruption of the blood supply to your brain can affect any of these functions.

A TIA doesn't cause any permanent damage to your brain, unlike a stroke. However, if you have one, you may be at risk of having a stroke in the following days and weeks. TIAs are most common in people over the age of 70, although they can happen at any age.

Symptoms of transient ischaemic attack

Symptoms of a TIA are similar to a stroke and usually come on suddenly, within seconds or minutes.

A good way to recognise if someone has had a TIA or stroke is to use the face-arm-speech-time to call 999 test (abbreviated to FAST). This involves checking for any one of the three main symptoms of stroke – facial weakness, arm weakness or speech problems. Other symptoms of TIA may include:

• numbness, weakness, clumsiness or pins and needles on one side of your body, for example in your arm, leg or your face
• sudden loss of sight in one or both eyes and blurred vision
• sudden memory loss or confusion

The symptoms of a TIA usually go away within an hour (usually in less than 10 minutes), but can last up to 24 hours. It's possible to have more than one TIA at a time and several within a day. If you notice that someone has any of these symptoms, you should call for emergency help straight away.

Causes of transient ischaemic attack

TIAs happen when the flow of blood to your brain is temporarily blocked, usually by a blood clot. The blood clot may develop in one of the blood vessels leading to your brain, or it may develop somewhere else in your body and travel to your brain in your blood.

You're at greater risk of getting a blood clot if your blood vessels have become narrowed and 'furred up' with fatty deposits – a process known as atherosclerosis. This often happens as people age. You can also develop atherosclerosis if you:

• smoke
• have uncontrolled high blood pressure
• have high cholesterol
• are overweight or obese
• have diabetes
• have a family history of stroke or heart disease
• drink regularly and heavily

You're also at risk of TIAs if you have a type of abnormal heart beat (arrhythmia) called atrial fibrillation. In atrial fibrillation, your heart doesn't pump blood as efficiently, which can cause a blood clot to form in your heart. This can then travel to your brain and cause a TIA or a stroke.

Diagnosis of transient ischaemic attack

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

You will have your blood pressure measured and an ECG to record the rhythm and electrical activity of your heart. You may then have blood tests to measure your cholesterol and blood sugar levels.

If your GP suspects you have had a TIA, he or she will refer you to a neurologist (a doctor specialising in diseases affecting the brain and nervous system). Alternatively, you may be referred to a doctor at a specialist TIA clinic. These are run at some hospitals and GP surgeries. If your GP thinks you're at risk of having a stroke after a TIA, you may need to go to hospital on the same day.

In hospital, other tests may be used to confirm whether you have had a TIA and what has caused it. For example, you may have:

• a brain scan (eg a CT or MRI)
• an echocardiogram, to check for heart disease
• a chest X-ray, to rule out other health problems
• a Doppler ultrasound of your carotid arteries (the main arteries leading to your brain) to check blood flow

The results of these tests will help your doctor to plan your treatment.

Treatment of transient ischaemic attack

If you have had a TIA, you’re at an increased risk of having a stroke. Without treatment, about one in six people who had a TIA will have a stroke within one month. Treatment of TIA is therefore aimed at trying to prevent another attack or a stroke.

Medicines

You may be prescribed one or more of the following medicines.

• Aspirin. This helps to reduce the risk of blood clots forming.
• Dipyridamole. You may be given this medicine as well as aspirin to further reduce your risk of getting a blood clot.
• Clopidogrel. This is used as an alternative to aspirin if you have side-effects.
• Warfarin. You may be given this medicine if your TIA was caused by a blood clot from atrial fibrillation. Warfarin slows down the blood clotting process.

You may also need medicines to reduce your blood pressure and cholesterol. There are many different types of medicines used to lower your blood pressure. It may therefore take a while to find the right one to suit you.

Surgery

Your doctor may advise that you have surgery. This can involve having an operation to remove the fatty deposits from an artery in your neck (carotid endarterectomy). It may help to reduce your risk of having a major stroke in the future. However, it's only suitable for people who have a very narrowed carotid artery on the side of their brain affected by the TIA.

Alternatively, you may be able to have a carotid angioplasty or a carotid stenting procedure. In both operations, your doctor passes a tube through a small cut in your groin to reach the carotid artery. Then, for angioplasty, he or she inflates a small balloon to widen the artery. In stenting, your doctor puts a small wire mesh into the artery to keep it open. This helps to reduce your risk of having another TIA or stroke.

Prevention of transient ischaemic attack

You can take steps to lower your risk of TIA by making changes to your lifestyle. Some examples are listed below.

• Stop smoking. This can greatly reduce your risk of TIA, no matter how old you are or how long you have been smoking.
• Don't exceed the recommended alcohol intake limits. By reducing the amount of alcohol you drink, you can reduce your blood pressure, which in turn reduces your risk of TIA and atrial fibrillation.
• Improve your diet. Reducing your cholesterol levels and salt intake can reduce your risk of TIA.
• Increase the amount of activity you do. Regular activity (150 minutes (two and a half hours) of moderate intensity exercise a week in bouts of 10 minutes or more) can help to lower your blood pressure and regulate the fat levels in your body.

If you have had a TIA, these lifestyle changes can also help to reduce your risk of having another attack and of you having a stroke.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.