What to Expect After a Transient Ischemic Attack (TIA)
Having a transient ischemic attack (TIA) can be frightening. TIAs have the same symptoms as a stroke, such as weakness on one side of the body, difficulty speaking, vision changes, and confusion. The difference is TIA symptoms resolve within minutes, although they can last as long as 24 hours. Doctors call TIAs mini-strokes or warning strokes, because if you have a TIA, you are at higher risk for stroke later.
TIA recovery is quick—as soon as symptoms stop. The problem is while you are experiencing symptoms, you don’t know if it’s a TIA or a stroke. It is only once the symptoms are gone and a doctor evaluates your blood vessels that you know. Learn more about what to expect after you’ve recovered from a TIA.
A TIA is a medical emergency, even if the symptoms have gone away. You may believe that if the symptoms have gone, you’re fine, but your risk of having a stroke is highest within the first few hours after a TIA and remains high for the week right after, so it is vital to get help as quickly as you can.
If you experience TIA symptoms, call 911 or have someone bring you to an emergency room right away. Once you are at the ER, the attending doctor will assess you and perform or order tests to determine why you had the symptoms.
The only way to determine the cause of your TIA and your risk for another TIA or stroke is through a series of tests. These tests also show if there has been any damage to your brain or heart.
A physical examination tells the emergency room doctor how you are in that moment. Part of that physical exam is a neurologic examination. The doctor looks at how you move your arms and legs, how you speak and smile, your eyes and vision, and your balance, among other things. Any changes could mean the TIA is not yet completely resolved.
Blood tests are an important part of the TIA examination. These tests can tell your doctor if there is something else going on, like an infection, or possible causes of the TIA, like high cholesterol levels, diabetes, blood that clots too rapidly, or other conditions.
Imaging tests allow your doctor to look for blockages or damage to your brain, carotid arteries (the arteries in your neck that bring blood to your brain), and your heart.
CT (computed tomography or CAT scan) uses special X-ray equipment and a computer program for a more detailed look at your brain and carotid arteries than an X-ray alone would show.
MRI (magnetic resonance imaging) provides a more specialized view of the brain using magnetic waves rather than radiation like X-rays.
Magnetic resonance angiography (MRA) is similar to an MRI, but first the doctor injects a dye through an intravenous (IV) line. The doctor watches the dye’s movement on a screen as the dye moves through the blood vessels throughout your body including the brain.
Ultrasound of the carotid artery will show if there are any blockages in the blood vessels.
Arteriography is a minimally invasive procedure. To perform an arteriogram, a radiologist makes a tiny incision in an artery, usually in the groin, to insert a long, narrow catheter. The doctor advances the catheter to the carotid artery. Dye is injected through the catheter into the artery and the dye’s movement is tracked with the blood flow.
Once your doctor makes the diagnosis, the next step is to refer you to the appropriate specialist or specialists who can develop your treatment plan based on the TIA cause. For example, if you have untreated diabetes, you may need a referral to an endocrinologist. If your problem is related to high cholesterol levels or heart disease, you may need a cardiologist. In turn, a cardiologist may refer you to a surgeon or an interventional radiologist if you need more invasive treatment, such a surgery.
Regardless of the specialist you see, chances are they will recommend you make lifestyle changes in addition to the treatment plan. These lifestyle changes, such as eating a low-fat, low-salt diet and exercising regularly, help promote a healthier lifestyle. Making these practices a part of your life not only reduces the risk of further TIAs or stroke, but other conditions, such as obesity, hypertension and diabetes.
A TIA is a medical emergency not because if its symptoms, but because of what a TIA means. Having a TIA is a warning that something is wrong with your vascular system and you are at risk for stroke. Doctors use a risk score—the ABCD2 score—to determine your risk for stroke after TIA. The score takes into account the following:
A: Age: 1 point if you are older than 60 years
B: Blood pressure: 1 point if the systolic (upper) number is higher than 140 or the diastolic (lower) number is higher than 90
C: Clinical features: 1 point if your speech was affected but you don’t have any weakness; 2 points if you have weakness, with or without speech difficulties
D: Duration: 1 point if the duration of the TIA was between 10 to 59 minutes; 2 points if it has been 60 minutes or longer
D: Diabetes: 1 point if you have diabetes
If you score a 6 or 7, there is an 8% risk of a stroke within 48 hours after the TIA. If you have a score of 4 or less, the risk is 1%. It’s important to keep in mind these percentages don’t mean you will have a stroke. They indicate your risk without treatment.
The definition of a TIA emphasizes that it is a transient, or temporary event. Therefore, TIA recovery occurs when the symptoms have gone away completely. If the symptoms do not go away, this is not a TIA, but a stroke.