Transient Ischemic Attack

Transient ischemic attack (TIA) is the condition in which there is decreased blood flow to the brain producing stroke like condition but lasting for few minutes.

This is often called a ministroke which may act as a warning to take further preventive steps.

About 1 in 3 people will have such attack again within a year if they had in past.

Fortunately, it does not cause any permanent damage.

Transient ischemic attack (TIA) most often lasts for a few minutes, and all signs and symptoms disappear within an hour.

Following are the symptoms of transient ischemic attack:

• weakness,
• numbness or paralysis in face, arm or leg typically in one side of the body;
• slurred or mixed speech;
• difficulty in understanding others,
• double vision,
• blindness in one or both eyes,
• dizziness,
• loss of balance,
• loss of consciousness

TIA if once occurred may occur again with either similar or slightly different symptoms depending on the area of the brain involved.

Transient ischemic attack (TIA) is caused by decreased or complete block of blood flow to the brain by a clot in the blood vessels supplying the brain.

Unlike ischemic attack, it lasts for few seconds and there is no permanent damage.

The underlying cause of clot formation is cholesterol build-up (atherosclerosis).

This clot may detach from that artery and move to other part of the body, most often heart may cause such symptoms.

Making a diagnosis of transient ischemic attack (TIA) is done on the basis of medical history and follow up tests.

Physical examination

• whooshing sound over atherosclerotic artery may be heard with a stethoscope,
• checking for tiny blood vessels in the back of the eye, high blood pressure using a sphygmomanometer, smell of rotten apples reveling ketonemia (a severe form of diabetes), weak and rapid pulse in the neck.

After assessing all these signs, the doctors would propose the following tests:

• Carotid ultrasonography (Ultrasound waves are passed through neck and the vessels are checked for blockage or narrowing),

• CT (cross-sectional view of blood vessels using X-ray),

• Computes tomography angiography scanning (CT associated with scanni8ng the blood vessel using contrast material),

• MRI (using electromagnetic field to view the blood vessels more clearly),

• TTE (a transthoracic transesophageal echocardiogram) involves moving an instrument across the chest through which sound waves are emitted. These waves echo from different part of the organ and create an ultrasound image.

• Arteriography (it gives a view of arteries in the brain that is not normally seen in X-ray).

Treatment depends on the location, cause, severity and type of transient ischemic attack (TIA) which include:

Medications

• Antiplatelet drugs (those drugs which prevent platelet aggregation),
• Anticoagulants (those drugs which affect clotting-system)
• Fibrinolytics (those drugs which dissolves the clot) can be used.

Surgery

Carotid endarterectomy is a procedure suggested by doctors when the carotid artery is severely narrowed. In this procedure, the artery is opened, plaques are removed and the artery is closed.

Angoiplasty

Inserting a balloon like device to open a clogged arteries and placing a small wire tube (stent) into the artery to keep it open.

The following preventive measures for transient ischemic attack (TIA) can be taken:

• avoid smoking,
• limit cholesterol and fat intake,
• eat plenty of vegetables and fruits,
• limit salt intake,
• exercise regularly,
• limit alcohol intake,
• maintain a healthy weight,
• avoid use of illicit drugs,
• control diabetes.

Transient ischemic attack (TIA) resolves on its own after few seconds of symptoms, therefore alternatives or homeopathic remedies are not required.

But in case of severe attack, emergency medical care should be seeked.

Lifestyle should be changed drastically after being diagnosed with transient ischemic attack (TIA) once because it tends to repeat. Lifestyle changes include:

• Smoking should be stopped completely,
• minimal intake of salt,
• avoiding fatty and fried food,
• exercising regularly,
• drugs should be stopped,
• being stress free,
• alcohol drinking should be stopped.

Also in order to prevent the chances of second or third time occurrence of TIA. There are special rehabilitation centers which help to quit smoking, drinking and drugs. They help to manage withdrawal syndromes and in turn help to fight with TIA. Meeting with people with similar conditions may help to recover quickly.  

Following are the risk factors of transient ischemic attack:

• Family history: Familial factor plays an important role in TIA, therefore, those people with family history may be under high risk of this attack.
• Age: Older people especially more than 55 years of age are at higher risk.
• Sex: Men are at higher risk of developing this disease, deaths due to stroke occur more in women.
• Prior transient attack: TIA in the past most often leads to more such attacks with a year.
• Sickle cell disease: Sickle shaped blood cell is not able to take enough oxygen and have tendency to stick to vessel wall leading to TIA.
• Race: Blacks are at high risk of TIA than others due to higher prevalence of hypertension and diabetes among them.

All these factors cannot be changed. Some additional risk factors which can be controlled are:

• High blood pressure: When blood pressure is more than 110/75, risk of stroke begins.
• High cholesterol: Cholesterol tends to get stuck to vessel wall and form plaque leading to blockage of blood flow.
• Cardio-vascular diseases: Heart infection, arrhythmias or heart failure may lead to stroke.
• Carotid artery disease: Blockage of this artery leads to clogging of artery to brain.
• Peripheral artery disease: Clogging of blood vessels that carry blood to extremities.
• Diabetes: it increases the risk of atherosclerosis leading to plaque formation and blockage of blood vessels.
• High level of homocysteine: This amino acid makes the artery thicken and narrow making them susceptible to clots.
• Excess weight: BMI (body mass index) more than 25 increases the risk of TIA due to fat accumulation and deposition.
• Cigarette smoking: Smoking is the one of leading cause of death due to various disease. In the case of TIA, smoking will lead to high blood pressure and cholesterol deposition in the blood vessel walls.
• Physical inactivity: Inactivity leads accumulation and deposition of fat thus increasing the risk of transient ischemic attack.
• Poor nutrition: Eating too much fat and salt leads to hypertension.
• Heavy drinking: Heavy alcohol drinking can increase the risk.

Use of illegal drugs and birth control pills also can be counted in the risk factors of TIA. It resolves on its own without any permanent damage, but in those cases, where there is an underlying cause like heart or blood vessel disease, then it may be fatal.