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Transient Ischaemic Attacks
Restricted blood flow can cause a TIA
What Is A Transient Ischaemic Attack?
A transient ischaemic attack (TIA) is also sometimes referred to as a mini stroke. The symptoms are very similar to those of a stroke but the difference is that they pass. This can mean an episode can last for as short as minutes to hours, but not longer than 24 hours. After 24 hours has elapsed, and symptoms persist then it is more likely to be a stroke.
What Are The Most Common Symptoms Of A TIA?
These symptoms are called focal neurological symptoms
- weakness, numbness, clumsiness or pins and needles on one side of the body e.g. arm, leg or face
- loss of, or disturbed vision in one or both eyes
- slurred speech or difficulty finding words
Non-focal symptoms such as faintness, non-specific dizziness, light-headedness, confusion, mental deterioration, incontinence, drop attacks or syncope do not suggest a TIA unless they are clearly accompanied by focal symptoms.
What Should I Do?
Never ignore the symptoms of a TIA. They might be a warning of a future stroke, which could be avoidable with treatment. About 1 in 4 people will go on to have a stroke within a few years of experiencing a TIA without treatment. Until you know exactly what has happened to you, you should not take any risks, by driving for example.
What Else Could It Be?
There are other possible explanations for these symptoms so it is vital that your doctor investigates the cause.
So get an urgent appointment to see your doctor.
You may be referred to a specialised TIA clinic where any necessary tests can be done in one visit.
What Causes A TIA?
Basically, as in a stroke, the blood supply to the brain is interrupted for some reason.
In a TIA the blood supply is temporarily cut-off by a blockage in a blood vessel. This means that the area of the brain that the affected blood vessel was supplying is deprived of oxygen and this disrupts the function of the cells involved. When the blood supply is re-established the symptoms pass. If the disruption to the blood supply is permanent, it may result in a stroke.
This can happen for 2 main reasons
- atheroma—build up of fatty tissue in the wall of the blood vessel narrowing the space that blood can get through, or temporarily blocking the flow altogether
- an embolus is a blood clot or particle of debris that travels round the body in the bloodstream until it becomes stuck in a narrow blood vessel in the brain. This could have been actually produced in one of the blood vessels.
What Contributes To This Happening?
There are certain situations that can contribute to these events, some of which we can control and some we cannot.
Lifestyle changes you can make to help reduce your risk are outlined in the section Reduce Your Risk Of Stroke
High Blood Pressure
Is one of the most important risk factors affecting TIA and stroke.
Over a period of time sustained high blood pressure can cause damage to the blood vessels.
Unfortunately there are not always symptoms to alert you to high blood pressure. It is often only discovered as a result of investigating something else, or in a routine examination.
Once it has been established that you have high blood pressure it is vital to control it.
Blood Stickiness
The stickiness of blood itself can affect the likelihood of a clot forming. This can be influenced by many other factors and can be assessed by blood tests.
Health Of Blood Vessels
Several factors that play a part in the general health of blood vessels involved
- narrowing of blood vessels is a natural part of ageing which we have no control over
- high blood pressure, high cholesterol levels and diabetes can all affect the health of blood vessels over a period of time. So it is important to know about and control these conditions as much as possible.
How Is A Diagnosis Made?
A diagnosis can be made based on your test results and by ruling out other possible causes of your symptoms .
Your doctor
- will ask you about your symptoms, how long they have lasted and whether they have occurred before
- will check your blood pressure and possibly do an electrocardiogram (ECG) if there is access to one in the surgery
- may need to send you to hospital for tests (see below) and investigations of your heart, the state of your arteries and to identify any other contributing factors
- might refer you to a stroke specialist; ideally within 2 weeks of reporting symptoms
What Tests Will I Need?
You may have all or some of the following
- blood pressure measurements
- blood tests to check clotting, blood sugar and cholesterol levels
- ECG to look for unusual heart rhythms
- chest x-ray to exclude other health problems
- CT scan to check for damage
- ultrasound scan of carotid arteries (blood vessels in the neck) to check blood flow
- echocardiogram to check for other forms of heart disease
Understanding Your Treatment
The main aim of treatment is to reduce the risk of a further TIA or possible stroke. This usually involves treatment with drugs.
Anti Platelet Treatment
If a TIA or a stroke is caused by blocking of a blood vessel most people are prescribed some form of anti platelet drug treatment.
Anti platelets have the effect of preventing the cells that clump together to make blood clot, called platelets, from sticking together. This has the effect of making the blood thinner and so flow more easily. There are 3 main antiplatelet drugs that can be useful in reducing the risk of further TIA and stroke
- aspirin
- dipyridamole
- clopidogrel
Aspirin
Aspirin is quite routinely used as a preventative measure in people considered to be at higher risk of developing cardiovascular related illness such as heart disease and stroke. It should however only be used in this way on the advice of your doctor.
Aspirin is very effective in reducing the risk of stroke at low doses (75mg per day) and is also very safe. Aspirin does not suit everybody and some people may not be able to take it.
Dipyridamole
Dipyridamole works in a slightly different way to aspirin, but has the same effect.
It is usually used in combination with aspirin but it can be used as an alternative to aspirin if aspirin cannot be tolerated. However, it is not suitable for everybody.
Combined Effect
Recent studies have confirmed that the combination of taking both aspirin and dipyridamole together is the most effective treatment to reduce the risk of further TIA and stroke.
Clopidogrel
Clopidogrel is mainly used in this context as an alternative to aspirin and dipyridamole because of side effects or allergy.
Anticoagulant Treatment
Some people with an irregular heart rhythm such as atrial fibrillation can have a TIA because a blood clot enters the blood stream from the heart. In this case it is likely that they will be prescribed an anticoagulant called warfarin. It works by preventing blood from clotting and so reduces the risk of TIA or stroke. However as it has this effect on all blood clotting there are associated dangers of bleeding. Treatment with warfarin requires careful monitoring and is not suitable for everybody.
People over 80 are not given warfarin routinely as they have an increased risk of complications from this treatment. The relative risks and benefits have to be discussed carefully before deciding on treatment.
See the Chest, Heart & Stroke Scotland (CHSS) Warfarin [46.7K PDF] factsheet for more detailed information.
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