Transient Ischemic Attack (TIA): 9 Things Doctors Want You to Know

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    What Brain and Stroke Specialists Say About TIAs
    Transient ischemic attacks (TIAs) affect about a half a million people every year in the United States. These mini-strokes, or warning strokes, should be taken seriously because for many people, they are a warning a more serious stroke may happen. Despite TIAs being fairly common, there are many things about them you may not know, like what causes a TIA, what treatment is available, and how TIAs may be prevented. The following three doctors share their answers and knowledge on these and other TIA facts.

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    1. “A TIA is a stroke about to happen.”
    TIAs are often referred to as mini-strokes and patients may dismiss them as unimportant. They think the symptoms aren’t a serious problem since they go away on their own, according to Shraddha Mainali, MD, a neurologist at The Ohio State University Wexner Medical Center. But this way of thinking is dangerous. “Mini doesn’t mean minor,” she explains. “The only difference between TIA and a stroke, is that somehow the body took care of the problem with a TIA, and the brain cells did not end up dying.”

  • Illustration of Narrowed artery
    2. “TIAs are caused by the same issues that cause strokes.”
    Most strokes are ischemic strokes, which means something blocked blood from flowing to the brain. “There may be some calcium deposit or fat deposit in the neck [carotid artery] that’s throwing off pieces [forming an embolus that moves away and blocks a smaller part of the blood vessel],” says neurologist Shazia Alam, MD, from NYU Winthrop Hospital, in Mineola, New York. “An irregular heartbeat can also cause blood clots to form in the heart that go to the brain.” The blockage deprives the brain tissues of vital oxygen and nutrients and the brain cells die. With TIAs, the blockage resolves before the brain tissue is damaged.

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    3. “A TIA is a medical emergency.”
    Even if the TIA symptoms have gone away, it is still a medical emergency. “We do still consider them like strokes so I consider them as medical emergencies,” explains Dr. Alam. “We would rather you call 911 and get evaluated. It's up to the doctors in the ER to either keep you there in the hospital for further work up or send you out. But we would rather patients get examined quickly, as soon as possible.”

  • older male patient with his daughter being seen by doctor
    4. “Not all TIAs are alike.”
    TIA symptoms vary between people, they’re not all the same, as Dr. Mainali explains. “Some may present with just language deficits, some may present with weakness, some may present with just numbness or vision changes,” she says. The symptoms are related to what part of the brain was affected. The most common symptoms are weakness on one side of the body, drooping on one side of the face, difficulty speaking or understanding, visual disturbances, and difficulty walking or keeping your balance.

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    5. “The highest risk of a stroke is within the first day of a TIA.”
    “The highest risk of you having another stroke or TIA is the first day and then the first week after you have a TIA,” says Mark L. Fehr, MD, MPH, a neurologist at Mercy Medical Center in Baltimore, Maryland. This is why doctors want patients to take TIAs seriously. The length of time you have the TIA symptoms doesn’t affect the risk of future TIAs. The concern comes from the fact there’s something wrong in your body causing the TIA in the first place.

  • Male patient getting blood pressure check from female doctor
    6. “High blood pressure is an important risk factor for TIAs and strokes.”
    Keeping your blood pressure within normal ranges is a good way to reduce your risk of a TIA. “It's ideal to have the blood pressure less than 140 for the upper number, or systolic number, and 90 for the lower number, or the diastolic number,” explains Dr. Mainali. “If a patient has diabetes too, it's ideal to have blood pressure less than 130 over 80.” Diabetes also increases your risk, so blood glucose (sugar) levels should be as controlled as much as possible in addition to blood pressure.

  • Hormone replacement therapy pills
    7. “Birth control pills or hormone therapy can increase TIA and stroke risk.”
    Although more men than women have TIAs and strokes, women have a unique risk if they take oral contraceptives or hormone replacement therapy. Dr. Mainali explains, “Women taking these should know that estrogen-containing pills are associated with a higher risk of stroke, so if they're on it and have stroke risk factors, or have history of TIAs or stroke, they should touch base with their physician to try and switch to some other methods of contraception.”

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    8. “Blood clots from the heart can cause a TIA or stroke.”
    As part of your work-up in the emergency room, you may have tests that look at your heart and how it is pumping. If your heart is beating too quickly, as with atrial fibrillation, blood clots can form in the heart and travel to your brain, causing a TIA or stroke. “The heart is the pump for the entire body, so if there are going to be blood clots in the heart, the first place they’ll go is the brain,” says Dr. Alam.

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    9. “The best treatment for a TIA is to prevent it.”
    When someone has a TIA, it’s a sign there is something going on inside the body, and treatment may prevent another TIA or a stroke. Treatment for a TIA may be as simple as taking medications to prevent blood clots or lower your cholesterol levels, although it also could involve more advanced procedures and surgery. But according to Dr. Fehr, the best treatment is to prevent TIAs in the first place. “This means making sure that you're doing all of the basic things for your chronic medical conditions, if you have any.” Control your blood pressure, cholesterol, and your diabetes if you have it. Eat right, exercise, and get enough sleep. Stop smoking if you smoke and don’t overdo it with the alcohol.

Transient Ischemic Attack (TIA): 9 Things Doctors Want You to Know
Contributors
  • Shraddha Mainali, MD - Healthgrades - Transient Ischemic Attack (TIA): 9 Things Doctors Want You to Know
    Shraddha Mainali, MD, neurologist and neurocritical care specialist, The Ohio State University Wexner Medical Center.
  • Shazia Alam, MD, Healthgrades - Transient Ischemic Attack (TIA): 9 Things Doctors Want You to Know
    Shazia Alam, MD, Director of Stroke Services at NYU Winthrop Hospital, in Mineola, NY.
  • Mark L. Fehr, MD, MPH - Healthgrades - Transient Ischemic Attack (TIA): 9 Things Doctors Want You to Know
    Mark L. Fehr, MD, MPH, a neurologist at Mercy Medical Center in Baltimore, Md.

About The Author

Marijke Vroomen Durning, RN, has been writing health information for the past 20 years. She has extensive experience writing about health issues like sepsis, cancer, mental health issues, and women’s health. She is also author of the book Just the Right Dose: Your Smart Guide to Prescription Medications and How to Take Them Safely.
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Last Review Date: 2021 Feb 6
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