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Health Encyclopedia - Diseases and Conditions
From Healthscout's partner site on diet and exercise, HealthCentral.com
Transient Ischemic Attack (TIA)
Definition of Transient Ischemic Attack (TIA)Article updated and reviewed by Associate Professor of Medicine / Neurology, Cooper University Hospital & Robert Wood Johnson Medical School. Editorial review provided by VeriMed Healthcare Network on May 2, 2005. A TIA is a brief interruption in the blood supply to the brain that leads to temporary neurologic deficits (such as weakness, numbness, or tingling). Description of Transient Ischemic Attack (TIA)Each year, over tens of thousands of Americans - most of them in their 60s and 70s - have at least one transient ischemic attack (TIA), a brief "mini-stroke", that temporarily reduces the blood supply to a specific area of the brain for less than 24 hours. Because the symptoms may go away spontaneously, they may be easily dismissed. But TIAs are a serious warning sign. Within five years of having one, about one-third of patients go on to develop a full-blown stroke, which may cause death or permanently impair vision, speech and movement. Clearly, identifying and treating those with TIAs can reduce the risk of stroke and preserve the quality of life of thousands of people each year.  Causes and Risk Factors of Transient Ischemic Attack (TIA)TIAs are usually caused by atherosclerosis (hardening of the arteries), due to buildup of cholesterol and other materials along the arterial walls. These materials form deposits called plaques, which narrow the artery and lead to the formation of blood clots that can cause complete blockage. There are two types of clots that can cause complete blockage. These are thrombotic (which form in the arteries leading to the brain); and embolic (which form in the heart or other arteries and travel to the brain). TIAs may occur when an artery serving the brain becomes so obstructed that an adequate amount of blood cannot pass through, or when a portion of the blockage breaks away from the arterial wall and travels to the brain. The episode resolves when blood flow is restored after the clot dissolves. Those at highest risk are men and women over age 60. The incidence is high among African-American men, people with diabetes (even when it is well controlled) or high blood pressure, and those with a family history of TIA or stroke. Heart disease (including angina, congestive heart failure, rhythm disturbances, and valve disorders) is also a risk factor. Symptoms of Transient Ischemic Attack (TIA)Symptoms, which are similar to those of stroke (and many other conditions), include weakness, tingling, or numbness in the arms and legs on one or both sides of the body; vision and language problems; confusion; vertigo (the sense that either you or the room is spinning); poor balance; and lack of coordination. Onset is sudden. By definition, symptoms of a TIA last up to 24 hours, while most pass within a few minutes to an hour. A TIA can not be confirmed until all symptoms have resolved. The natural history of attacks is variable. Some patients will have a major stroke after only a few TIAs, while others may have frequent attacks for weeks or months without having a stroke. Attacks may occur intermittently over many years, or they may stop spontaneously. Diagnosis of Transient Ischemic Attack (TIA)Diagnosis is based on the medical history and the physical examination, which may be normal. An electrocardiogram (EKG), chest x-ray, head CT (computed tomography) scan and an ultrasound study of the carotid arteries (in the neck) may be performed. An echocardiogram (ultrasound study of the heart) may also be recommended. Other conditions that cause transient neurological symptoms, such as seizures and low blood sugar, may need to be excluded. Treatment of Transient Ischemic Attack (TIA)Lifestyle changes are standard, whether the blockage is caused by plaque or clots. This includes improved exercise and dietary habits. If the carotid artery is blocked, procedures may be recommended to restore normal circulation. The degree and nature of blockage will determine whether intervention is helpful. Other factors, such as the condition of other arteries going to the brain and one’s general medical health, are also considered. One technique to restore normal flow is through surgery (endarterectomy) in which the artery is opened up and plaque is physically removed. A newer technique involves placing a stent (a stiff hollow tube) in the area to prevent further closure of the artery. This is done through a catheter placed into the arteries and may be a better option for some patients. Medical treatment is centered on reducing as many risk factors as possible, such as quitting smoking, control of hypertension and diabetes, and reducing cholesterol. Patients may be prescribed antiplatelet medications (drugs that discourage plaque formation by preventing platelets from sticking together). Aspirin is by far the most commonly used antiplatelet drug. Other similar medications include clopidogrel (Plavix), ticopidine (Ticlid) and a combination of aspirin and dipyridamole (Aggrenox). Some patients may benefit from a combination of these drugs, depending on the presence of other medical conditions such as blocked arteries in the heart or legs. If a patient is determined to have an abnormal heart (such as a weak heart muscle) or rhythm disturbances (such as atrial fibrillation), they may need to use a blood thinner such as coumadin. In other patients, abnormal openings in the heart may allow clots to abnormally pass through to the brain. In such patients heart surgery may be able to reduce the risk of future TIA or stroke. If a patient is determined to have abnormal clotting of the blood (such as with some hereditary clotting disorders), they too may need coumadin or other blood thinners. What Questions To Ask Your Doctor About Transient Ischemic Attack (TIA)How serious is a TIA? Is there significant atherosclerosis? Is there a risk of a stroke? Will you prescribe an antihypertensive drug? Should aspirin be taken? What changes in lifestyle are necessary? Is surgery necessary? Prevention of Transient Ischemic Attack (TIA)One way to prevent TIAs is to adopt the same strategies that reduce the likelihood of stroke. By far, the most effective measure is to keep blood pressure controlled, since high blood pressure promotes atherosclerosis. Even borderline hypertension (130 to 139 mm Hg/85 to 89 mm Hg) increases risk of TIA and stroke. Recommendations include trying to:
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