Transient Ischemic Attack (TIA): Symptoms, Causes & Treatment

Transient ischemic attack (TIA) is a temporary interruption of blood flow and oxygen to the brain due to a blocked artery. It can cause neurological symptoms such as tingling on one side of the body, difficulty speaking, or facial drooping.

Although it causes symptoms similar to a stroke, a transient ischemic attack usually lasts only a few minutes. Symptoms go away on their own and do not cause permanent damage in most cases.

However, a TIA is an important warning sign because it may indicate an increased tendency to form blood clots. For this reason, it requires immediate evaluation in the emergency department, often with follow-up care from a neurologist, as it increases the risk of having a stroke soon afterward.

TIA symptoms

The main symptoms of a transient ischemic attack are:

• Paralysis and tingling on one side of the face

• Weakness and tingling in the arm and leg on one side of the body

• Difficulty speaking clearly

• Blurred or double vision

• Difficulty understanding simple instructions

• Sudden confusion

• Sudden headache

• Dizziness and loss of balance

These symptoms are intense for a few minutes but usually go away completely within about 1 hour after they start.

A transient ischemic attack can cause symptoms very similar to those of a stroke and, even if they disappear quickly, it can still be followed by a stroke in the next few hours.

According to the American Heart Association, stroke-like symptoms that disappear within an hour still need emergency assessment because TIA is linked to a high risk of future stroke.

Can a TIA cause lasting effects?

In most cases, a transient ischemic attack does not cause permanent effects, such as difficulty speaking, walking, or eating. This is because the interruption in blood flow is brief and rarely causes serious injury.

However, depending on how long it lasts, how severe it is, and the area of the brain affected, some people may have mild residual effects.

Confirming a diagnosis

A transient ischemic attack is diagnosed by a primary care provider, neurologist, or emergency physician based on the symptoms reported, when they started, and how long they lasted. The provider will also consider the person’s personal and family medical history.

In addition, tests such as blood tests, brain imaging (CT scan or MRI), carotid ultrasound, and assessment for conditions such as atrial fibrillation may be ordered to rule out non-vascular conditions, such as tumors or hypoglycemia, and to identify the underlying cause.

According to the American Heart Association, urgent evaluation is recommended because stroke risk is highest soon after a TIA. These evaluations should be performed as soon as possible, ideally within the first 24 hours after the TIA.

Possible causes

A transient ischemic attack occurs when an artery in the brain becomes blocked, which may be caused by:

• Large artery thrombosis

• Cardiac embolism

• Large artery disease, such as atherosclerosis or stenosis

• Atrial fibrillation

• Vasculitis

• Previous heart attack

• Structural abnormalities of the heart

In addition, some factors can increase the risk of TIA, such as high blood pressure, high cholesterol, diabetes, smoking, obesity, older age, and a history of stroke or previous TIA.

Other conditions, such as sleep apnea, peripheral artery disease, alcohol or drug use, and high homocysteine levels, may also contribute.

Treatment options

Treatment for transient ischemic attack recommended by a doctor includes:

1. Medication

The main medications used for a transient ischemic attack include:

• Antiplatelet medications, such as aspirin or clopidogrel, as they help prevent blood clots

• Anticoagulants, such as warfarin, heparin, rivaroxaban, dabigatran, or edoxaban, especially if the TIA was caused by atrial fibrillation or other heart problem

• Statins, such as rosuvastatin and atorvastatin, to lower cholesterol

• Blood pressure medications, to control blood pressure

In people with diabetes, diabetes medications, such as metformin, may be recommended to control blood sugar levels.

2. Surgery

In some cases of TIA caused by severe narrowing of the arteries, surgical procedures such as angioplasty with stent placement may be recommended. This procedure involves opening the narrowed artery and inserting a stent to keep it open, restoring blood flow.

Carotid endarterectomy may also be recommended. This surgery involves removing fatty or calcium plaques that are blocking the artery, helping prevent new episodes of TIA or stroke.

3. Healthy habits

After a transient ischemic attack, it is also important to adopt healthy habits that help reduce the risk of new TIAs or strokes.

This includes following a healthy diet rich in fruits, vegetables, and fiber, and low in fat and salt. Regular physical activity and maintaining a healthy weight are also important.

It is also important to avoid smoking, reduce alcohol intake, and manage stress. These measures complement medication treatment and help protect the brain in the long term.