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Transient Ischemic Attacks (TIAs)

TIAs - a warning sign of stroke
A stroke is a “brain attack” that occurs when blood flow to an area of the brain is interrupted. It is the number one cause of chronic adult disability in the United States and affects 750,000 people annually.

What are transient ischemic attacks?
Transient ischemic attacks, also called TIAs or mini-strokes, are brief episodes of stroke symptoms that typically last less than 24 hours. Generally, no permanent loss of abilities is noticed by individuals after a TIA.

TIAs should never be ignored!
More than one-third of all persons who experience TIAs will go on to have an actual stroke:
• 5 percent of strokes will occur within 1 month of the TIA or first stroke
• 12 percent will occur within one year
• 20 percent will occur within two years
• 25 percent will occur within three years

What are the symptoms of TIAs?
The symptoms of TIAs are the same as for stroke but may differ depending on which part of the brain is affected:
• Sudden numbness or weakness of face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you experience any of these symptoms, for even the briefest amount of time or notice them in someone else, seek medical attention immediately. Don’t wait for the symptoms to go away, because you cannot tell whether you are having a stroke or a TIA. If you are having aTIA, your doctor can evaluate and treat the causes and set up a plan of action to prevent a stroke. Unfortunately, most people who have TIAs don’t seek treatment, either because the symptoms come and go quickly and are painless or because they think their symptoms are caused by old age, fatigue, etc. Once you have had a TIA, you are at high risk for another TIA or a full stroke if not treated.

What are the different causes of TIAs?
TIAs are generally caused by three things:
• Low blood flow at a narrowing in a major artery to the brain, such as the carotid artery.
• Blood clot in another part of the body, such as the heart, breaking off and temporarily lodging itself in a brain blood vessel.
• Narrowing in one of the smaller blood vessels in the brain, stopping blood flow temporarily.

How is the cause of TIA diagnosed?
Diagnosing the cause of a TIA may include blood tests to look for clotting problems. Diagnostic tests such as ultrasound scanning, magnetic resonance imaging (MRI), or a CT scan may also be used to look for the source of the problem. These type of tests take x-rays or images of the arteries and blood vessels to determine blood flow rate or the possibility of blockages. Heart-related problems such as valvular disease or irregular heart beat may also be explored.

How can TIAS be managed?
Management of TIAs is focused on preventing a future stroke. The therapy used depends on the exact cause of the TIA. Your physician may prescribe a variety of medications to treat high blood pressure, high cholesterol or heart disease to reduce your risk of further TIA or stroke. After a TIA occurs, there are several clot prevention medications available to help reduce the risk of a full stroke. Aspirin is the least expensive and longest standing clot-preventing medication. A newer, more effective option is a combination of aspirin and extended-release dipyridamole, called Aggrenox®. Clopidogrel (Plavix®) and ticlopidine (Ticlid™) are other options your doctor might consider. Warfarin (Coumadin™) is commonly prescribed to prevent clots from forming in patients with atrial fibrillation.

Furthermore, according to recently published results of the PROGRESS trial in the journal Lancet, patients who experienced a TIA or stroke reduced their risk of further stroke by 28 percent when given perindopril erbumine (Aceon®), and by 36 to 76 percent when given perindopril with the diuretic indapamide. If TIAs are caused by a partial blockage in the carotid artery, surgery may be required to open the artery and prevent a stroke (endarterectomy). Talk with your health care provider about what the best stroke prevention options are for you. Then be a partner in your own good prevention plan. Lifestyle adjustments are especially important. If you are smoking, stop. Also adopt healthy eating habits by lowering the fat in your diet, and eating more fresh fruits and vegetables.

Controllable risk factors
You have control over many stroke risk factors. The National Stroke Association and its panel of stroke specialists have developed ten simple guidelines to help you reduce your risk of stroke.
1. Know your blood pressure. If it is elevated, work with your doctor to keep it under control. A normal blood pressure is considered less than 130/85.
2. Find out if you have atrial fibrillation which is an irregular heartbeat rhythm (also called AF). If you have AF, work with your doctor to manage it.
3. If you smoke, stop.
4. If you drink alcohol, do so in moderation.
5. Know your cholesterol number. If it is high, work with your doctor to control it.
6. If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.
7. Include exercise in the activities you enjoy in your daily routine.
8. Enjoy a lower sodium (salt), lower fat diet.
9. Ask your doctor if you have circulation problems which increase your risk for stroke. If so, work with your doctor to control them.
10. If you have any stroke symptoms, seek immediate medical attention.

Uncontrollable risk factors include being over age 55, male or African American; having a family history of stroke; and a personal history of diabetes.

For more information contact:
National Stroke Association
1-800-STROKES (1-800-787-6537)

This information was sponsored by an unrestricted educational grant from Solvay Pharmaceuticals, Inc.

This information was developed by the National Stroke Association and is herewith used with permission.

This information was developed by the Last accessed June 28, 2004.

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