Also called ‘mini-strokes’, Transient Ischemic Attacks (TIA) are relatively harmless in terms of immediate consequences. Transient ischemic attacks last only for a few minutes when blood supply to a part of the brain gets blocked. Like most other strokes, TIA is also caused by blockages or blood clots within brain. Nevertheless, these temporary TIA episodes are considered to be ‘warning strokes’ because they indicate the likelihood of a stroke which may be in the coming. Therefore TIAs must be taken seriously even though there is a possibility that clots may eventually dissolve or dislodge on its own & stop causing any symptoms. Quite often TIA symptoms occur & are similar to ischemic strokes with a difference that these only last for less than five minutes at the most. Moreover, when TIA is over, it does not cause any permanent injury to brain. Taking medications like blood thinners can reduce risk of stroke in future for TIA patients. Sometimes doctors also recommend surgery for TIA cases while a healthy lifestyle like quitting smoking, avoiding too much liquor, consuming a healthy diet & exercise will also help lower risk. TIA patients should also keep their cholesterol & high blood pressure under control.
Causes of Transient Ischemic Attacks
TIA has the same origin as ischemic strokes during which a clot is found to block blood supply to a part of the brain. However, unlike a stroke blockage is quite brief in TIA & will subsequently not cause any permanent damage. Most often, the underlying cause of TIA is a buildup of plaques or cholesterol-containing fatty deposits (atherosclerosis) within arteries or branches supplying nutrients & oxygen to brain. These fatty deposits usually end up decreasing flow of blood through an artery or sometimes lead to the development of blood clots. Blood clots sometimes move through into an artery supplying blood to brain from some other part of the body like the heart may also be the cause in some TIA patients.
It is very important to keep track of blood pressure on a routine basis after it has been diagnosed. It would, therefore, be sensible for a patient to invest in home blood pressure equipment which will be helpful in regular monitoring. Tracking blood pressure at home will provide doctors an accurate assessment of routine blood pressure & thereby enable them prescribe & adjust medications more accurately. Patients should also make it a point to check blood pressure immediately when they experience dizziness, vertigo, disturbances in gait & lack of coordination. Patients must immediately call up the doctor or visit a local emergency room or urgent care center in these conditions in case they are not having any ways to check blood pressure at home. Many times high blood pressure will lead to damage of inner walls of arteries. Moreover, it can create plaque which will rupture & lead to the formation of blood clots within arteries. Eventually, these are the same abnormalities which are found to lead to TIA. Other risk factors on TIA include conditions like obesity, smoking, diabetes, high cholesterol & atrial fibrillation. Some studies also suggest that men are more likely to experience TIA than women. Research has also revealed that older people are at more risk of TIA than younger people.
Signs & Symptoms of Transient Ischemic Attacks
It is easy to mistake TIA as a minor condition due to the fleeting nature of symptoms & absence of long-term damage. Moreover, it may also be difficult to identify TIA. Nevertheless, the following conditions may be helpful in indicating TIA.
- Issues with Balance
- Trouble with Speech
- Changes in Vision
- Muscular Weakness which is typically on one side of the body
TIA can also cause the following:
- Altered Level of Consciousness
- Passing Out
- Abnormal Sense of Smell
- Abnormal Sense of Taste
- Numbness or Weakness on one side of face or body
However, it is the location of a blood clot within the brain which will determine as to where this weakness may occur.
Dysphasia – Quite often, people with TIA will find themselves unable to speak, albeit temporarily. Later on, they may tell doctors that they had difficulty in recalling words during the attack. Other problems with speech can include trouble in understanding or be uttering words. This condition is known as dysphasia & many times is the only symptom of a transient ischemic attack. Trouble in speaking during TIA indicates blockage or blood clot which is occurring in the dominant brain hemisphere.
Temporary Blindness in One Eye – This particular visual disturbance is known as Transient Monocular Blindness (TMB) & which manifests during TIA. Vision in the TIA patient’s one eye suddenly becomes dim or obscured during the attack. Lasting for seconds or minutes, vision among TIA patients may turn gray or objects can look blurred. Moreover, exposure to bright lights will worsen or aggravate conditions. It will also be difficult for the TIA patient with TMB to read words on white pages.
Due to the fact that TIA is short-lived, doctors usually diagnose this condition based upon the medical history of the event instead of what is found during the neurological or physical examination. However, doctors will rely on the following tests in order to determine cause & to assess the risk of stroke in future.
- Tests & Physical Examination – Doctors will usually check for diabetes, high blood pressure, high cholesterol levels, risk factors for stroke & high levels of amino acid homocysteine. With help of a stethoscope, they will listen for a bruit (whooshing sound) over arteries which indicate the presence of atherosclerosis. They will also look out for emboli (platelet fragments) or fragments of cholesterol within tiny blood vessels of the retina at the back of the eye. This examination is performed with help of an ophthalmoscope.
- Carotid Ultrasonography – This is a transducer which is a wand-like device capable of sending high-frequency sound waves into the neck of the patient. When these sound waves pass through tissue & revert, doctors can analyze the images they create on screen & search for narrowing or clotting within carotid arteries.
- Computerized Tomography (CT scan) – These scans of the head region use x-ray beams that help in assembling a composite 3D picture of the brain.
- Computerized Tomography Angiography (CTA scan) – CT scans of the head can also be used for evaluating other arteries in the neck & the brain. CTA scan x-rays are similar to standard CT scans of the head but may additionally involve injecting of contrast material into blood vessels.
- Magnetic Resonance Imaging (MRI) – This is a procedure which utilizes strong magnetic fields which are capable of generating composite 3D views of the patient’s brain.
- Magnetic Resonance Angiography (MRA) – This type of MRI procedure evaluates arteries within neck & brain by using strong magnetic fields which are similar to standard MRI. However, additionally, a contrast dye is injected into the blood stream which can indicate narrowing or blocking of the blood vessel.
- Echocardiography – Doctors may also choose to perform a transesophageal echocardiogram (TEE) or transthoracic echocardiogram (TTE). TEE involves placing a flexible probe with the inbuilt transducer in the esophagus which connects the back of the mouth to the stomach. Since esophagus is located directly behind heart it is possible to create clear & detailed ultrasound images from here. Moreover, it also allows the better view of blood clots which may not be visible in traditional echocardiography examination. TTE procedure involves moving the transducer across the patient’s chest. Sound waves which echo off the heart create ultrasound images in the TTE examination.
- Arteriography – This examination provides a view of arteries within the brain which are not possible to be seen through traditional x-ray imaging. For this purpose radiologists will insert a catheter through a small incision which is usually made in the groin region. Subsequently, the catheter is manipulated through major arteries into the vertebral or carotid artery. A contrast dye is then injected through the catheter & x-ray images of arteries within the brain are taken. However, this examination is performed only for select cases.
Treatment Options for Transient Ischemic Attacks
The goal of transient ischemic attack treatment is to correct abnormality & prevent stroke once the doctor has determined the cause. However, depending upon the cause of TIA, doctors will either prescribe medications in order to reduce the tendency for formation of blood clots or recommend angioplasty or surgery.
- Medications – There are many medications which doctors use for decreasing likelihood of stroke following TIA. However, the choice of prescription is based on the cause, location, severity & type of transient ischemic attack. Two of the most frequently prescribed drugs for TIA include the following.
- Anti-Platelet Drugs – These medicines are meant to make platelets less likely to stick with one another. Platelets are one of the types of cells circulating in the blood. Sticky platelets usually form clots whenever blood vessels are injured. This is a process to overcome injury & is completed by clotting of proteins in blood plasma. Aspirin is one of the most frequently used anti-platelet medications. Moreover, it is least expensive & has very few potential side effects. Another antiplatelet alternative to aspirin is drug clopidogrel (Plavix). Some doctors may also prescribe Aggrenox, which is a combination of antiplatelet drug dipyridamole & aspirin for reducing blood clotting in TIA cases. Dipyridamole is found to work slightly different from how aspirin does.
- Anticoagulants – Heparin & warfarin (Coumadin, Jantoven) are the most common anticoagulant drugs. Instead of affecting the functioning of platelets, these affect the proteins of the clotting system. While warfarin is a drug which is useful in the long term, heparin is prescribed for a short period of time. However, careful monitoring is very important with these drugs. In case atrial fibrillation is also present, doctors usually prescribe dabigatran (Pradaxa), which is another type of anticoagulant, for TIA patients.
- Angioplasty – This is known as carotid angioplasty & stent placement procedure which is a TIA treatment option in selected cases. It involves using a catheter with a balloon-like device for opening clogged arteries & placing a small stent (tube) into the artery at the narrowed or blocked the site in order to keep it open.
- Surgery – Carotid endarterectomy is a surgery which is suggested by doctors for TIA patients having moderate to severely narrowed carotid (neck) arteries. This, in fact, is a preventive measure designed to clear carotid arteries of atherosclerotic plaques (fatty deposits) prior to the occurrence of another transient ischemic attack or stroke. Carotid endarterectomy procedure involves making an incision to open the artery & subsequently removing plaques before the artery is closed again.
Preventive Measures for Transient Ischemic Attacks
Living healthy & understanding risk factors is the best way to prevent transient ischemic attacks. However, following the suggestions are given below & undergoing regular check-ups as part of a healthy lifestyle will help in preventing TIA.
- Quit Smoking – Quitting smoking will be very helpful in reducing the risk of TIA or strokes.
- Limiting Fat & Cholesterol – It is essential to cut back on fat & cholesterol, especially trans-fats & saturated fats in the diet. This will help in reducing the buildup of plaques in arteries.
- Eating Plenty of Vegetables & Fruits – Both fruits & vegetables are found to contain nutrients like potassium, folate & antioxidants. These are very helpful in protecting a person from transient ischemic attacks & strokes.
- Exercise Regularly – Regular exercise is an effective way of lowering blood pressure without the help of drugs. This is especially beneficial for people having high blood pressure.
- Limiting Sodium – People having high blood pressure must avoid adding salt to food or stop intake of salty foods in order to reduce & keep blood pressure in check. Though avoiding salt will not prevent hypertension, but excessive intake of sodium is known to increase blood pressure in people who are reactive to sodium.
- Limit Alcohol Consumption – Alcohol should be consumed in moderation if required. The normal recommended dose of alcohol consumption is one drink for women every day & two for men.
- Controlling Diabetes – It is possible to manage both, diabetes & high blood pressure, with exercise, diet, weight control & medications if required.
- Maintaining Healthy Weight – Being obese or overweight contributes to risk factors of several medical conditions including diabetes, cardiovascular disease & high blood pressure. Therefore, weight loss with help of exercise & diet will help in improving cholesterol levels & for lowering blood pressure.
- Do Not Use Illicit Drugs – Illicit drugs like cocaine & others are generally associated with increased risk of having transient ischemic attacks or strokes.
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