Patient Information - Transient Ischaemic Attacks

1. What is a transient ischaemic attack?

Transient Ischaemic Attacks (TIA's for short), are a type of mini-stroke. The symptoms may be very like a stroke but they get better very quickly. Common symptoms include brief attacks of weakness, clumsiness, numbness or pins and needles of the face, arm or leg on one side of the body. Temporary slurring of speech or difficulty in finding words can also occur. The eye can also be affected resulting in loss of vision in one eye. This is called Amaurosis Fugax. These attacks may only last for a few minutes or hours and are usually better within a day.

2. What causes TIA's?

TIA's and strokes are caused by narrowing and blockages of the blood vessels that supply the brain. The trouble is due to hardening of the arteries (atherosclerosis) a condition which develops as we get older and is associated with smoking, high blood pressure, high cholesterol levels and diabetes. In TIA's small clots and particles from the diseased artery wall pass with the blood flow into the brain and cause small temporary blockages. The symptoms depend on which blood vessel to the brain or eye is blocked.

3. Are there any other causes?

There are several illnesses which may seem very much like TIA's. These include migraine, epileptic fits or seizures, a low blood sugar, faints and changes in heart rhythm. TIA's do not usually cause "blackouts", fainting or loss of consciousness. These other illnesses need different treatments and it is important that people with TIA symptoms are seen by a specialist to find out the cause of the trouble.

4. Why are TIA's important?

Although TIA's may be frightening they do not cause any permanent damage. However, a person who has had a TIA has a higher risk of suffering a stroke. The risk of having a stroke in the first year after a TIA is about 10% and about 5% each year after this. It is important that TIA's are investigated so that any underlying cause can be corrected to try to prevent a stroke in the future.

5. What tests are required?

If your specialist thinks that your symptoms are a cause for concern, then a series of tests will be arranged. These usually include blood tests for high cholesterol and diabetes, a blood pressure check and a heart tracing (ECG). Sometimes TIA's are due to narrowing of a blood vessel in the neck (carotid artery). A painless ultrasound scan of the neck will check on this.

6. What about treatment?

Your treatment depends on the results of your examination and tests.
If you smoke you should stop completely.
High blood pressure and high sugar levels in the blood need to be controlled by diet and medication.
Treatment to “thin” the blood and reduce clot formation is also beneficial. Low dose aspirin (75mgs) is commonly used and has few side effects. Some patients get indigestion and antacids can help this or other agents such as clopidogrel (Plavix) or dipyridamole (Persantin) can be used. This reduces the risk of having a stroke or heart attack by about 25%.
Statins are a group of medications that reduce cholesterol levels and also help prevent strokes. Most patients with a TIA benefit from a statin.
If the ultra sound scan suggests that the carotid arteries in the neck are narrowed, then a procedure to correct the narrowing may be necessary. This is achieved by either placing a stent in the artery under x-ray control, or by a surgical operation called a carotid endarterectomy. Further tests may be arranged before the procedure including an x-ray of the arteries (arteriogram/MRA) and a scan of the brain (CT scan). More detailed information about these procedures is available from your specialist.