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Transient ischaemic attack (TIA)

Published by Bupa's health information team, March 2009.

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

A TIA is sometimes called a mini stroke. It happens when the blood supply to your brain is interrupted very briefly, causing symptoms similar to a stroke, but which only last for a short time.

• About TIAs
• Symptoms of TIAs
• Causes of TIA
• Diagnosis of TIA
• Treatment of TIA
• Further information
• Questions and answers
• Related topics
• Sources

About TIAs

Blood vessels called arteries carry blood to various parts of your body, including your brain.

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

A TIA doesn't cause any permanent disability, although it may cause irreversible damage to your brain which may only be noticeable on a brain scan. However, if the blood supply to your brain becomes permanently blocked, it will cause a full-blown ischaemic stroke (see related topics). A TIA is a sign that you are at risk of having a full stroke.

Symptoms of TIAs

Symptoms of a TIA usually come on suddenly, within seconds or minutes. They usually go away within an hour (typically within two to 15 minutes) but they can last up to 24 hours. They may include:

• numbness, weakness or clumsiness on one side of the body, for example in an arm, leg or your face
• difficulty speaking
• sudden loss of sight in one eye or blurred vision

A good way to recognise whether someone has had a TIA or a stroke is to use the face-arm-speech test (abbreviated to FAST). This involves checking for three of the main symptoms of TIA and stroke - facial weakness, arm weakness and speech problems.

If you or someone has any of these symptoms, you should seek urgent medical attention. Even though the symptoms of a TIA may only last a few minutes, someone who has a TIA could be at immediate risk of having a more severe form of stroke.

Causes of TIA

TIAs and ischaemic strokes occur when the flow of blood to your brain is blocked, usually by a blood clot. The blood clot may develop in one of the arteries leading to your brain, or it may develop somewhere else in your body and travel to your brain in your blood. If the blockage is temporary, it causes a TIA, whereas if it's permanent, this results in a stroke.

You are at greater risk of getting a blood clot if your arteries have become narrowed and 'furred up' with fatty deposits - a process known as atherosclerosis. This often happens as people age. However, the following risk factors can also speed up the process:

• smoking
• uncontrolled high blood pressure
• high cholesterol
• being overweight or obese
• diabetes
• a family history of stroke/heart disease

You are also at risk of TIAs and ischaemic stroke 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, where it blocks an artery. Regular, heavy drinking can put you at risk of developing an abnormal heart rhythm. It can also raise your blood pressure.

Diagnosis of TIA

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

Your GP may carry out some initial tests, including:

• blood pressure tests
• blood tests, to check your cholesterol and blood sugar levels, and blood clotting potential
• an ECG (electrocardiogram) - this measures the electrical activity of the heart and can identify unusual heart rhythms

If your GP suspects you have had a TIA, he or she will refer you to a neurologist - a doctor specialising in diseases affecting your brain and nervous system. Alternatively, you may be referred to a doctor at a specialist TIA clinic, which are run at some hospitals and GP surgeries.

You may have the following tests to confirm whether you have had a TIA, and what has caused it:

• an MRI or CT scan - an MRI scan uses magnets and radiowaves to produce images of your brain; CT uses X-rays to make a three-dimensional image of your brain
• echocardiogram to check the valves and structure of your heart
• chest X-ray
• ultrasound of your carotid arteries (the main arteries leading to your brain) - ultrasound uses sound waves to produce an image of the inside of the arteries, allowing doctors to check how well the blood is flowing

Treatment of TIA

Treatment of TIA is aimed at trying to prevent another attack or a stroke.

Self-help

There are several things your doctor may advise you to do to reduce your risk of getting another TIA or a stroke. These include:

• giving up smoking - smoking can speed up the narrowing of your arteries and make your blood more likely to clot
• reducing your salt intake - salt increases your blood pressure
• limiting the amount of fat in your diet - fatty foods can raise the cholesterol level in your blood
• making sure you eat at least five portions of fruit and vegetables a day - anti-oxidants in fruit and vegetables may help to protect your blood vessels from damage
• reducing your alcohol intake and avoiding binge drinking
• increasing your level of physical activity - regular exercise can help to lower blood pressure and assist with weight loss

Medicines

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

• aspirin - this helps to stop platelets in your blood from sticking together and forming clots; if you have side-effects to aspirin, you may be given an alternative medicine called clopidogrel
• dipyridamole - you may be given this in addition to aspirin, to further reduce your risk of getting a blood clot
• warfarin, If you have an arrhythmia (irregular heartbeat)
• medicines to reduce your blood pressure - there are many different types of medicine available, and it may take a while to find the right one to suit you
• medicines to reduce your cholesterol - the most common ones are called statins

Surgery

You may be advised to have a procedure called a carotid endarterectomy, which can reduce your risk of getting a stroke. The procedure involves removing the fatty deposits in one of the main arteries supplying your head and neck. If you are advised to have it, it will usually be carried out within two weeks of you having a TIA. The procedure is only suitable for some people - your doctor will advise you if it's suitable for you.

Further information

• The Stroke Association
  0845 3033100
  www.stroke.org.uk

Related topics

• Haemorrhagic stroke
• Ischaemic stroke
• Stroke

Sources

• Transient ischaemic attack - not in atrial fibrillation. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 9 December 2008
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:606-607
• Transient ischaemic attack (TIA). The Stroke Association, October 2006, Factsheet 01. www.stroke.org.uk
• What is a stroke? The Stroke Association. www.stroke.org.uk, accessed 12 November 2008
• Cardiovascular disease. British Heart Foundation. www.bhf.org.uk, accessed 12 November 2008
• British Heart Foundation. Alcohol and heart disease. June 2007. www.bhf.org.uk
• National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009