Transient Ischemic Attack (TIA, Mini-Stroke) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Transient ischemic attack (TIA) facts
- What is a transient ischemic attack (TIA)?
- What are the causes of transient ischemic attack (TIA)?
- What are the risk factors for transient ischemic attack (TIA)?
- What are the symptoms of transient ischemic attack (TIA)?
- How is transient ischemic attack (TIA) diagnosed?
- What is the treatment for transient ischemic attack (TIA)?
- What is the prognosis for transient ischemic attack (TIA)?
What is the prognosis for transient ischemic attack (TIA)?
A transient ischemic attack should be considered a major warning sign of an impending future stroke. Up to 10% of people will experience a stroke within three months of TIA. Since there is no way of predicting that stroke-like symptoms will resolve, the patient and family need to be educated should symptoms occur, they need to access medical care emergently activating the emergency medical services system and calling 911.
If a stroke occurs, there is a very short period of time where thrombolytic (clot dissolving) drugs, (for example, alteplase [TPA]), can be used to reverse a stroke. In most hospitals, the drug can only be given within 4 1/2 hours of onset of stroke symptoms. In that time frame, the patient needs to get to the hospital, the diagnosis needs to be made, laboratory tests and head CT scans need to be performed, neurologic consultation needs to occur, and the drug administered. The longer the delay, there is a higher the risk that the drug won't work and that complications such as bleeding into the brain will occur.
Specialized interventional radiologists can inject TPA directly into the clot that has blocked the blood vessel in the brain. This can extend the time frame to six hours, but currently this treatment is not widely available.
TIAs should be considered the equivalent of angina of the brain. In heart disease, angina is the heart pain that warns of potential heart attack. When heart muscle is damaged, it cannot be replaced or repaired. Similarly, brain tissue is at risk when there is decreased blood supply and it, too, cannot be replaced.
REFERENCE: AHA/ASA Guideline: Guidelines for the Early Management of Adults with Ischemic Stroke. Stroke 2007,38: 1655-1711
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