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Transient Ischaemic Attacks (TIAs) and Minor Strokes

What is a transient ischaemic attack (TIA)?

A transient ischaemic attack is called a TIA for short.

  • The symptoms are very similar to those of a stroke but the difference is that they pass (transient).
  • Ischaemic is the term used to refer to insufficient blood supply.

A TIA can last for a couple of minutes to several hours, but not longer than 24 hours.


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What is a minor stroke?

After 24 hours has elapsed, and symptoms persist, it becomes a 'minor' or 'small' stroke.

The term minor is used because it refers to minimal damage. Any stroke is frightening and very significant to the person experiencing it.


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What are the most common symptoms of a TIA or minor stroke?

Focal symptoms (focal relates to the specific area within the brain)

  • weakness, numbness, clumsiness or pins and needles on one side of the body for example face, arm or leg
  • loss of, or disturbed vision in one or both eyes
  • slurred speech or difficulty finding words

Non–focal symptoms: other symptoms which may accompany the above include:

  • faintness, non–specific dizziness, light headedness
  • confusion, mental deterioration
  • incontinence
  • drop attacks or syncope

Non–focal do not suggest a TIA unless they are clearly accompanied by focal symptoms.

Remember that there are other possible explanations for these symptoms so it is vital that your doctor investigates the cause. Migraine, epilepsy, anaemia and heart arrhythmia can all give similar symptoms and all need to be treated.

  • Never ignore the symptoms of a TIA : they might be a warning of a future stroke, which could be avoidable with treatment. There is a 10% risk of stroke in the first week after a TIA. Until you know exactly what has happened to you, you should not take any risks, e.g. by driving.

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Think FAST!

think FAST and save a lifeFAST is a quick reference tool used to help people recognise the symptoms of TIA and stroke. It requires an assessment of 3 specific symptoms of stroke.

  • Facial weakness - can the person smile? Has their mouth or eye drooped?
  • Arm weakness - can the person raise both arms?
  • Speech problems - can the person speak clearly and understand what you say?
  • Time to call 999 If a person has failed any of these tests it is crucial to call 999.

If a person has failed any of these tests it is crucial to call 999.

Stroke is a medical emergency and by calling 999 you can help someone reach hospital quickly and receive the early treatment they need.


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What causes a TIA / minor stroke?

A TIA or minor stroke occurs because the blood supply to the brain is interrupted for some reason.

Diagram of restricted blood flowIn 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 formation, i.e. 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 (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.

There are certain situations that can contribute to these events, some of which we can control and some we cannot.

  • 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: factors that play a part in the general health of blood vessels involved include:
    • Narrowing of blood vessels: this 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. It is important to know about and control these conditions as much as possible.

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How will I be diagnosed?

It is likely that you will be seen by a stroke specialist either at the hospital or at a TIA clinic. You will be asked about your symptoms, what they were, how long they lasted and if they have happened before.

You will need some tests and investigations to check your heart, the state of your arteries and identify any other factors that may have contributed to your symptoms.

A diagnosis can be made based on your test results and by ruling out other possible causes of your symptoms.


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What tests will I need?

Your doctor will decide which tests and investigations you need. These may include:


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Understanding your treatment

The main aim of treatment is to reduce the risk of a further TIA or possible stroke. The same risk factors apply to stroke and heart disease. This called cardiovascular risk.

Your treatment may involve:

  • Anti platelet treatment

    If a TIA or a stroke is caused by blocking of a blood vessel you may be prescribed some form of anti platelet drug treatment. Anti platelets prevent platelets, the cells that clump together to make blood clot, from sticking together. This makes the blood thinner and able to flow more easily. There are 3 main antiplatelet drugs that can be useful in reducing the risk of further TIA and stroke:

    • 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: this works in a slightly different way to aspirin, but has the same effect. It is usually used in combination with aspirin as this has been found to be more effective than taking aspirin alone in reducing the risk of further stroke after a TIA. However it is not suitable for everybody.
    • Clopidogrel: this is mainly used in this context as an alternative to aspirin and dipyridamole because of side effects or allergy.

    After a TIA it is recommended that you have a single dose of 300mg aspirin followed by 75mg aspirin and 200mg modified release dipyridamole thereafter.

    After a stroke it is recommended that you have 300mg daily for 14 days then 75mg thereafter.

  • Anticoagulant treatment

    Irregular heart rhythms such as atrial fibrillation (AF) can sometimes cause a TIA / minor stroke. This is because a blood clot enters the blood stream from the heart.

    In this case it is likely that you 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.

    Note: new anticoagulants are now becoming available. The first of these is called dabigatran. They may be suitable for some people with AF. Phone the Advice Line nurses on 0845 077 6000 for more information.

  • Lowering high blood pressure

    Controlling high blood pressure involves taking regular blood pressure lowering drugs, having your blood pressure monitored regularly and making changes to your lifestyle.

    If you have had a TIA or minor stroke you may be given blood pressure lowering drugs (e.g. ace inhibitors and thiazide diuretics) as a protective measure, even when your blood pressure is not raised.

  • Controlling diabetes

    If you have diabetes you are considered to be at a higher risk of developing heart disease or stroke compared to those who do not. Uncontrolled diabetes causes damage to the blood vessels and the build–up of fatty deposits in the arteries.

    If you have Type 2 diabetes you are also more likely to have high LDL ('bad') cholesterol and high blood pressure. If you have had a TIA or a minor stroke it is important to control your diabetes.

  • Lowering cholesterol

    Having a high cholesterol level can contribute to the build up of atheroma in the blood vessels. If your cholesterol is found to be high you will be given advice about how to reduce the amount of fat in your diet. The most commonly used group of drugs to do this are called statins.

    After a TIA or minor stroke it is likely that you will be asked to take statins even if your cholesterol is not high.

  • Carotid surgery

    If your symptoms show that the area of the brain called the carotid territory is involved you may have an ultrasound scan of your carotid arteries in your neck. This should be performed as soon as possible after the onset of your symptoms.

    This scan shows if you would benefit from an operation called carotid endarterectomy, which can be performed to reduce the risk of a future stroke. Carotid endarterectomy clears a narrowed carotid artery of debris. Both carotid arteries can require surgery, however this would not be performed at the same time.

    Not everyone is suitable for this type of surgery. Carotid endarterectomy carries risks so it will only be considered by specialist surgeons for people who are considered fit enough.


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What can I do to help myself?

If you have had a TIA you are at greater risk of a stroke. There are certain things (called risk factors) that further increase your risk of stroke. The same risk factors apply to both stroke and heart disease. Together they are called cardiovascular risk factors.

Eat Well Plate © Crown copyright source: Department of Health in association with the Welsh Government, the Scottish Government and the Food Standards Agency in Northern Ireland. Some cardiovascular risk factors are to do with the way you lead your life. Making changes to these lifestyle risk factors can improve your overall health and reduce your risk of stroke and heart disease.




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© Chest Heart & Stroke Scotland 2012 | Page last updated on Wednesday 21st March, 2012

Registered with and regulated by the Office of the Scottish Charity Regulator (charity no SC018761), Chest Heart & Stroke Scotland and CHSS are operating names of
The Chest, Heart & Stroke Association Scotland. Also registered in Scotland as a company limited by guarantee, no SC129114.