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Author: Julia Barrett
Source: Gale Encyclopedia of Medicine


Transient Ischemic Attack


Definition


A transient ischemic attack, or TIA, is often described as a mini-stroke. Unlike a stroke, however, the symptoms can disappear within a few minutes. TIAs and strokes are both caused by a disruption of the blood flow to the brain. In TIAs and most strokes, this disruption is caused by a blood clot blocking one of the blood vessels leading to the brain. The blockage produces symptoms such as sudden weakness or numbness on one side of the body, sudden dimming or loss of vision, and difficulty speaking or understanding speech. If the symptoms are caused by a TIA, they last less than 24 hours and do not cause brain damage. Stroke-associated symptoms, on the other hand, do not go away and may cause brain damage or death. TIAs can serve as an early warning sign of stroke and require immediate medical attention.


Description


Strokes are the third leading cause of death in the United States and the leading cause of disability. Approximately 500,000-600,000 people have strokes each year, and more than 160,000 die as a result. About 85% of these strokes are classified as ischemic. In ischemic stroke, a blood vessel leading to the brain becomes blocked and an area of the brain is deprived of oxygenated blood. (The other 15% of strokes are caused by bleeding from a blood vessel that has ruptured.) Without the blood supply, the cells in that area of the brain die. Since brain cells cannot grow back, the functions that are controlled by that brain area may be permanently lost.


Approximately 10% of strokes are preceded by one or more TIAs. The estimated annual number of TIAs is about 50,000; an exact count is difficult because TIAs are not always reported. They may be under-reported because they typically last less than an hour, perhaps only for a few minutes. Because they are so brief, TIAs may not seem important. However, an estimated one-third of all TIAs are followed by a stroke within five years. They are considered a medical emergency and prompt medical attention is very important.


Risk factors for strokes and TIAs are very similar. The risk of a TIA or stroke is higher among men, African Americans, people over age 65, and people with heart disease or diabetes. Smokers, people with high blood pressure, and people who are overweight also have a greater risk for TIAs and strokes.


Causes & Symptoms


A TIA is caused by a temporary blockage of one of the arteries that leads into the brain. Small blood clots, called microemboli, are the immediate cause of the blockage. The blockage forms because of damage or disease within the circulatory system. Blood clots can form in blood vessels because of artery damage, heart disease, and other cardiovascular problems. For example, atherosclerosis is strongly associated with TIAs. Atherosclerosis is the build-up of fatty deposits or plaque at certain areas in the circulatory system. Clotting cells in blood, called platelets, tend to stick to atherosclerotic plaques or other damaged sites within blood vessels. Occasionally, a clot may grow large enough to block a blood vessel, or a piece of a clot may break off and circulate to other areas of the body. If a clot does not dissolve quickly enough, it can lodge in a blood vessel and block it. In TIAs, the microemboli dissolve within a short time.


Blood flows into the brain through two main pathways: the carotid arteries and the vertebrobasilar arteries. The carotid arteries are located on the front of the neck; the vertebrobasilar arteries are at the base of the skull at the back of the head. The symptoms produced by a TIA are determined by the arteries affected.


If a vertebrobasilar artery is blocked, common symptoms include double vision and dizziness, nausea and vomiting, difficulty speaking, and problems understanding and using spoken words. There may also be a numbness around the mouth and a tingling sensation in the limbs. Blockage of a carotid artery produces complete loss of vision, dimmed or foggy vision, and paralysis or weakness on one side of the body. These symptoms may also be accompanied by language problems and speech difficulty.


With either type of blockage, the microemboli dissolve within hours and full function returns.


Prognosis


One-third of TIAs are followed by stroke in next five years; in the other two-thirds, the TIAs may either continue or disappear on their own. However, because of the risk of stroke-related disability and death, all TIAs should be treated as emergency medical situations.


Prevention


Treatment for TIAs is complemented by lifestyle changes. These practices may also prevent TIAs and strokes from ever occurring. Doctors and other health-care providers universally recommend that individuals stop smoking and consume alcohol in moderation. Regular health checkups can detect high blood pressure, heart disease, and other underlying problems. Adhering to treatment for these problems can help minimize TIA and stroke risks. Finally, maintaining a healthy weight and engaging in regular exercise as able are strongly recommended.


Key Terms


Angioplasty -A medical procedure in which a catheter, or thin tube, is threaded through blood vessels. The catheter is used to place a balloon or stent (a small metal rod) at an area of stenosis and expand it mechanically.


Arteriography -A medical test in which an x-ray visible dye is injected into blood vessels. This dye allows the blood vessels to be imaged with x rays.


Atherosclerosis – A build-up of fatty tissue called plaque inside arteries that can impede or block blood flow.


Carotid Artery – One of the major blood vessels leading to the brain; it runs up the front of the neck.


Echocardiography – A type of ultrasonography that is used to create an image of the heart and its functioning.


Endarterectomy – A surgical procedure in which diseased tissue and atherosclerotic plaque are removed from the inside of an artery.


Ischemia – A condition in which blood flow is cut off or restricted from a particular area. The surrounding tissue, starved of oxygen and nutrients, dies.


Microemboli – Small blot clots in the bloodstream.


Platelets – Tiny cells in the blood that help form blood clots.


Stenosis – The narrowing of an opening or passageway in the body. In arteries, stenosis is caused by a build-up of atherosclerotic plaque, disease, or other disorder.


Stroke – A condition in which blood flow to the brain has been blocked, thereby causing brain cells to die from lack of oxygen and nutrients; also called a “brain attack.”


Ultrasonography – A medical test in which sound waves are directed against internal structures in the body. As sound waves bounce off the internal structure, they create an image on a video screen.


Vertebrobasilar Arteries – Major blood vessels that lead to the brain. They are located at the base of the skull at the back of the head.