All About Transient Ischaemic Attacks

Transient ischaemic attacks (TIAs), sometimes referred to as ‘mini-strokes’, are often ignored because symptoms improve and the immediate effects are minimal. However, they are a warning sign that must be taken seriously (American Stroke Association 2018).

What is a Transient Ischaemic Attack?

A transient ischaemic attack (TIA) is essentially a minor stroke that often lasts for a short duration of time. It is caused by a temporary blockage of the blood supply to the brain, starving it of oxygen and nutrients (Stroke Foundation 2017).

Unlike a stroke, where the prolonged blockage causes brain cells to die and results in permanent damage, a TIA will generally resolve after only a few minutes (though it may last for up to 24 hours). This allows the oxygen and nutrients to quickly return to the brain, and the patient will fully recover with no lasting effects (Stroke Foundation 2017; Better Health Channel 2013).

However, a TIA can be a warning that a full-blown stroke is imminent. For this reason, TIAs should be treated as an emergency and should never be ignored (American Stroke Association 2018).

What is the Risk of Stroke After a TIA?

Approximately one in three people who experience a TIA will go on to have a stroke. This does not necessarily mean a stroke will occur within the next few hours; it may eventuate months or even years after the TIA. The riskiest period is the following year after a TIA, wherein half of the eventual strokes will occur (Mayo Clinic 2020).

The following factors may increase the risk of stroke after a TIA:

• The TIA lasts for over 10 minutes;
• The patient experiences weakness and speech difficulties during the TIA;
• The patient is over 60 years old;
• The patient has high blood pressure; and
• The patient has diabetes.

(Better Health Channel 2013)

Risk Factors for a TIA

• Age (people over 55 are at increased risk);
• Gender (men are slightly more at risk);
• Family history of TIA or stroke;
• Previous TIAs;
• High blood pressure or cholesterol;
• Cardiovascular disease;
• Artery disease;
• Diabetes;
• High levels of homocysteine;
• Increase in body mass index;
• Smoking;
• Lack of exercise;
• Poor diet;
• Heavy alcohol consumption; and
• Illicit drugs.

(Mayo Clinic 2020)

Signs of a TIA

The symptoms of a TIA are virtually identical to those of a stroke, but will generally resolve within an hour. They include:

• Severe, sudden headache;
• Temporary blindness or blurred vision;
• Vision disturbances (e.g. double vision);
• Speech disturbance (e.g. using the wrong words);
• Slurred speech;
• Facial numbness or weakness;
• Difficulty swallowing;
• Weakness or paralysis of the face, arms or legs;
• Vertigo;
• Loss of balance; and
• Nausea and vomiting.

(Healthdirect 2018)

Remember the FAST test:

F (Face)	Has the patient’s face drooped?
A (Arms)	Can the patient lift both arms?
S (Speech)	Is the patient’s speech slurred? Can they understand you?
T (Time)	Time is critical. Any of these signs could indicate a stroke.

(Stroke Foundation 2015)

Treating a TIA

When a patient experiences a TIA, the primary goal is to prevent a stroke from occurring.

1. At the onset of a TIA:
   • Escalate care.
   • Conduct a head-to-toe assessment.
   • Ensure the patient is safe.
   • Reassure the patient.
   • Increase the frequency of observation (neurological assessment and vital signs).
   • Commence basic life support if the patient is unresponsive.
   • Coordinate diagnostic testing.
   • Clearly document the patient’s signs and symptoms.


2. The patient should undergo a full assessment to confirm the incidence of a TIA. This may include:
   • Carotid imaging;
   • Electrocardiogram (ECG);
   • Blood tests;
   • Blood pressure measurement;
   • Physical examination;
   • Chest x-ray;
   • CT scan; and
   • Echocardiogram.


3. Brain imaging and appropriate investigations should be performed.


4. The patient should commence antithrombotic therapy as soon as possible.


5. Lifestyle risk factors should be identified and modified. These may include:
   • Smoking cessation.
   • Improving diet.
   • Increasing exercise.
   • Limiting alcohol.


6. Other inventions may include:
   • Blood pressure-lowering therapy;
   • Cessation of hormone replacement therapy;
   • Diabetes management;
   • Antiplatelet therapy;
   • Anticoagulation therapy;
   • Lipid-lowering medicines;
   • If the occlusion is greater than 70%, the patient may undergo carotid endarterectomy surgery to remove plaque from the carotid artery.


7. Ensure education about driving is delivered by the medical practitioner before the patient is discharged.

(Stroke Foundation 2010, 2017; Better Health Channel 2013)

Preventing TIAs

Lifestyle changes may be able to prevent the likelihood of experiencing a TIA or stroke.

• Refrain from smoking;
• Limit cholesterol and fat;
• Ensure you maintain a healthy diet;
• Limit sodium intake;
• Exercise regularly;
• Limit alcohol consumption;
• Maintain a healthy weight;
• Avoid illicit drugs; and
• Manage underlying conditions such as diabetes, high cholesterol, high blood pressure or atrial fibrillation.

(Mayo Clinic 2020; NHS 2020)

Conclusion

Early detection and prompt treatment of a patient who has experienced a TIA is imperative in ensuring the best outcome and reducing the likelihood of stroke. Remember to escalate care if a patient is demonstrating the signs and symptoms of a TIA or stroke.

Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on stroke and TIA management.

Additional Resources

• Brain Foundation
• Stroke Foundation
• Stroke Foundation, Clinical Guidelines for Stroke and TIA Management
• Different Types of Strokes

References

• American Stroke Association 2018, What is a TIA, American Stroke Association, viewed 1 June 2020, https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack/what-is-a-tia
• Better Health Channel 2013, Transient Ischaemic Attack (TIA), Better Health Channel, viewed 1 June 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/transient-ischaemic-attack-tia
• Healthdirect 2018, Transient ischaemic Attack (TIA), Healthdirect, viewed 1 June 2020, https://www.healthdirect.gov.au/transient-ischaemic-attack-tia
• Mayo Clinic 2020, Transient ischaemic Attack (TIA), Mayo Clinic, viewed 1 June 2020, https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/symptoms-causes/syc-20355679
• NHS 2020, Transient ischaemic Attack (TIA): Prevention, NHS, viewed 1 June 2020, https://www.nhs.uk/conditions/transient-ischaemic-attack-tia/prevention/
• Stroke Foundation 2010, Clinical Guidelines for Stroke and TIA Management, viewed 1 June 2020, https://strokefoundation.org.au/-/media/FBADA4FE5BA54F99832F105C4550660C.ashx?la=en
• Stroke Foundation 2015, Stroke Symptoms, Stroke Foundation, viewed 1 June 2020, https://strokefoundation.org.au/About-Stroke/Stroke-symptoms
• Stroke Foundation 2017, Transient Ischaemic Attack (TIA), Stroke Foundation, viewed 1 June 2020, https://strokefoundation.org.au/About-Stroke/Types-of-stroke/Transient-Ischaemic-Attack-TIA