Transient Ischemic Attack (TIA)

What is a transient ischemic attack?

A transient ischemic attack is like a temporary stroke. It means there’s a temporary (transient) lack of blood flow to part of your brain. Without blood flow, the brain cells malfunction and start to die (ischemia).

Often shortened to TIA, a transient ischemic attack is a medical emergency that’s very similar to an ischemic stroke. The symptoms of the two are the same, but TIA symptoms go away within 24 hours (most go away in minutes).

IMPORTANT: A transient ischemic attack is a medical emergency just like a stroke is. That’s because there’s no way to predict how long a TIA will last, and every minute counts. Seek immediate medical help if you have signs of stroke, including balance issues, vision changes, face and arm drooping, and speech difficulties.

If you or someone you’re with has TIA or stroke symptoms, you should immediately call 911 (or the local emergency services number in your area). Don’t wait to see if the symptoms will subside, and don't avoid calling if the symptoms get better after a few minutes of resting. A TIA can be the precursor to a stroke, so get medical attention right away!

TIA vs. mini-stroke — which is the correct name?

A common nickname for TIAs is “mini-strokes.” But that’s not an accurate name. A TIA isn’t necessarily “mini” or smaller, and TIAs can easily affect large brain areas. Importantly, a stroke may occur after a TIA, within a matter of minutes, hours or days.

There are also two critical differences between strokes and TIAs. The first is that a TIA stops on its own. A stroke doesn’t, and it needs treatment to stop and reverse the effects. A stroke also leaves behind evidence on a magnetic resonance imaging (MRI) scan. The changes remain even if your symptoms go away.

What are the symptoms of a TIA?

The possible symptoms of a TIA are nearly identical to the possible symptoms of a stroke.

The symptoms of an ischemic stroke can involve one or more of the following:

• One-sided weakness or paralysis (hemiplegia).
• Difficulty with or loss of speaking ability (aphasia).
• Slurred or garbled speaking (dysarthria).
• Loss of muscle control on one side of your face or facial droop.
• Sudden loss — either partial or total — of one or more senses (vision, hearing, smell, taste and touch).
• Blurred or double vision (diplopia).
• Loss of coordination or clumsiness (ataxia).
• Dizziness or vertigo.
• Nausea and vomiting.
• Neck stiffness.
• Emotional instability and personality changes.
• Confusion or agitation.
• Memory loss (amnesia).
• Headaches (usually sudden and severe).
• Passing out or fainting.

What causes a TIA?

Transient ischemic attacks and ischemic strokes happen for the same reasons. Those reasons include:

• Formation of a clot in your brain (thrombosis).
• A fragment of a clot that formed elsewhere in your body that breaks free and travels through your blood vessels until it gets stuck in your brain (thromboembolism).
• Small vessel blockage (lacunar stroke).
• Cryptogenic TIA (the word “cryptogenic” means “hidden origin,” so these are TIAs that happen with an unknown cause).

What are the risk factors for this condition?

Many factors can contribute to a TIA or make one more likely to happen. Risk factors include:

• High blood pressure (hypertension). This is the most significant of all risk factors for TIA. It’s one of the reasons why managing blood pressure is so essential.
• Type 2 diabetes.
• Tobacco use (especially smoking or vaping).
• Atrial fibrillation (Afib). This irregular heart rhythm (arrhythmia) can cause blood to swirl and pool in one of your heart’s chambers rather than smoothly flow through. That can allow clots to form, and these can then travel through your carotid arteries and into your brain.
• A history of stroke or TIA. Having a previous stroke or TIA raises the risk of having a TIA.

Other risk factors that can contribute to a TIA include:

• Heart disease and a previous heart attack (especially a recent one).
• High cholesterol (hyperlipidemia).
• Having excess weight or obesity.
• Nonmedical drug use (including recreational drugs) and alcohol overuse.
• Age. As people age, their blood vessels become less flexible for several reasons. That can contribute to atherosclerosis, narrowed blood vessels and other concerns that can contribute to a TIA.

What are the complications of a transient ischemic attack?

The main reason that a TIA is a medical emergency is because it’s often a warning that a stroke is possible or even imminent. Up to 20% of people who have a TIA have a stroke within 90 days, and half of those strokes happen within the first two days after a TIA.

How is a transient ischemic attack diagnosed?

A healthcare provider can diagnose a TIA using a combination of methods, including:

• Medical history. This involves asking you questions about your health history and symptoms.
• Physical and neurological exam. These help a provider learn more about your symptoms, especially if you’re still experiencing them at the time of the exam.
• Imaging scans. Healthcare providers can get a computed tomography (CT) scan in only a few minutes. It helps them to quickly see if you’re having a brain bleed or not and, if so, provide treatment immediately. An MRI scan helps your care team tell if you had a stroke or a TIA. If there's visible damage (even though your symptoms are completely gone), it was a stroke, not a TIA.

Other tests may also be possible, depending on your symptoms and if your healthcare provider suspects another health issue is causing or contributing to the TIA and its symptoms. Your healthcare provider can tell you more about the tests they recommend and why those tests could be helpful.

How is a transient ischemic attack treated?

A TIA, by definition, is a temporary issue. But it indicates that a stroke — which isn’t temporary — could happen. That means treating the condition(s) that caused the TIA can help prevent a stroke.

Healthcare providers often recommend treating these conditions aggressively. That’s because a stroke is a much more serious — and dangerous — condition. Strokes are also often more difficult to treat. It’s also because even with treatment, strokes can cause permanent damage or death.

The most common treatments to prevent a stroke after a TIA include:

• Medications.
• Catheter-based procedures.
• Surgery.

Medications for post-TIA stroke prevention

Many types of medications can help treat the conditions that cause or contribute to a TIA and prevent TIA or stroke from happening in the future. They include:

• Aspirin. This is one of the most common medications that healthcare providers recommend. It helps prevent stroke by reducing your risk of blood clots. Other alternatives include clopidogrel (Plavix®), ticagrelor (Brilinta®) and Aggrenox (a combination pill of aspirin and dipyridamole).
• Blood pressure medications. These help reduce pressure strain on your blood vessels from the inside. Common medications for this include calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics and more.
• Statins. Statins are cholesterol-lowering medications. They generally reduce low-density lipoprotein (LDL) cholesterol levels in your blood. That’s the cholesterol that can build up inside blood vessels, narrowing them and causing atherosclerosis. Atorvastatin (Lipitor®) and rosuvastatin (Crestor®) are effective and likely the best-known of these medications.
• Blood thinners. These medications make it harder for your blood to clot, which can lower the risk of a clot forming and getting stuck in a blood vessel in your brain. These include anticoagulants like warfarin (Coumadin®), apixaban (Eliquis®), rivaroxaban (Xarelto®) or dabigatran (Pradaxa®). These medications are often recommended if you have atrial fibrillation or blood clots in your heart.

Catheter-based procedures

“Endovascular procedures” is the blanket term for all procedures that use thin, tube-like devices threaded into your blood vessels through very small incisions in your skin. Endovascular means “inside a blood vessel,” and these procedures treat problems from the inside without full surgery.

These usually involve your carotid arteries, the main vessels that carry blood from your heart to your brain. Narrowing (stenosis) in your carotid arteries can lead to a TIA or a stroke.

Some examples of endovascular procedures that can help prevent a stroke after a TIA include:

• Endovascular thrombectomy. This is a procedure to remove the blood clot. It opens up the artery, restoring blood flow to your brain.
• Stenting. This involves placing a stent, a mesh scaffold-like device, inside a blood vessel. The stent helps hold open narrowed blood vessel sections so blood can flow through.
• Angioplasty. This involves a catheter with a balloon attachment at its tip. Inflating the balloon can widen narrowed arteries.

Endarterectomy

When catheter-based procedures aren’t possible, surgery may be an option to widen blood vessels. That can prevent another TIA or stroke. An example of a surgery like this is carotid endarterectomy to clean up the plaque and create a wider space for blood to flow through into your brain.

Procedures for other conditions that can contribute to a TIA

Other procedures are also possible, depending on what conditions you have. For example, your cardiovascular or cerebrovascular care team may determine that your TIA or stroke is due to conditions like patent foramen ovale (PFO), a hole in the wall that separates the lower two chambers of your heart. PFO can allow blood clots to travel to your brain. Your provider may recommend closing the hole to reduce the odds of having a stroke.

Can a transient ischemic attack be prevented?

Sometimes, but not always. Many TIAs happen for preventable reasons. But a TIA can also happen for unpredictable or unexpected reasons.

You can do many things to reduce your risk of having an ischemic stroke. While this doesn’t mean you can prevent a stroke, it can lower your risk. Actions you can take include:

• See a primary care provider yearly for a checkup (this can detect symptomless concerns like high blood pressure and Type 2 diabetes sooner).
• Reach and maintain a weight that’s healthy for you.
• Manage what you eat (your primary care provider can guide you on this).
• Stop using tobacco products (or don’t start using them in the first place).
• Use alcohol only in moderation and avoid nonmedical drug use.
• Take prescription medications exactly as instructed.
• Manage any chronic conditions you have (such as high blood pressure, Type 2 diabetes and high cholesterol).

What can I expect if I have a transient ischemic attack?

Having a TIA is like having a temporary stroke. If they happen while you’re active, the symptoms may stop or lessen if you rest because you don’t feel well. However, the symptoms can return quickly once you resume whatever you were doing.

Because a TIA and a stroke have the same possible symptoms, you should always call 911 (or your local emergency services number) immediately. There’s no way to tell if what you’re experiencing is a stroke or a TIA while it’s happening.

How long do transient ischemic attacks last?

How long TIAs last can vary. By definition, TIAs last less than 24 hours. But it’s rare for a TIA to last even that long. Most TIAs last for only minutes.

What’s the outlook for transient ischemic attack?

The outlook for a TIA depends strongly on what’s causing it and what you do about it. Without treatment, your stroke risk within the next 90 days — especially the first two days after the TIA — can be very high.

The outlook is best when you get immediate emergency medical care. Healthcare providers can make sure that what you had was a TIA and not a stroke, and they can find out what’s causing or contributing to your TIA. That can also determine how to treat the underlying issue and what you can do to prevent further issues.

How do I take care of myself after a TIA?

Once you receive care, it’s essential for you to follow your healthcare provider’s guidance. The closer you follow it, the better the odds that you won’t have another TIA or stroke. Because TIAs can happen for different reasons, what you should do to take care of yourself may vary.

In general, the same actions or precautions that prevent TIAs or lower your risk of having one are also what you should do after you have a TIA. Your healthcare provider can also guide you specifically on what you can and should do.

When should I see my healthcare provider?

After emergency treatment for a TIA, you should see a provider for follow-up care. They can recommend a schedule for follow-up visits as needed and help you monitor for any changes in symptoms and how well treatment is working.

When should I go to the emergency room?

You should immediately call 911 (or your local emergency services number) and go to the nearest emergency room if you have any stroke-like symptoms. If you previously had a TIA, you should call 911 (or your local emergency number) and go to the nearest ER if any of the symptoms return.

Several other conditions are possible if you recently had a TIA. You should get emergency care if you experience symptoms of any of the following conditions:

• Deep vein thrombosis (DVT).
• Pulmonary embolism.
• Heart attack.

What questions should I ask my doctor?

• Did I have a TIA or a stroke?
• What were the underlying causes or factors that contributed to my TIA?
• What kind of changes can or should I make to prevent another TIA or a stroke?
• What treatments are available to prevent another TIA or a stroke?
• What are the possible side effects of medications or treatments that I should watch for?
• What are the symptoms that mean I need to go to the ER?

How common are transient ischemic attacks?

TIAs are very common. Experts estimate there are about 500,000 per year. However, there’s evidence that estimate is too low. The reasons for that include:

• TIAs are temporary. People may not realize what they’re experiencing. If the symptoms go away quickly, they may not go to the hospital or get medical attention.
• TIAs don’t leave behind evidence. Imaging scans can’t detect a TIA after it ends. If there are visible changes left behind, it was a stroke, not a TIA.
• TIAs often precede strokes. People may have a stroke shortly after a TIA, but not realize what the TIA was.
• There are many TIA mimics. Many conditions can cause stroke-like symptoms but aren't actually strokes. By the time a person gets to the hospital, it may not be possible to tell what caused their symptoms.

A note from Cleveland Clinic

A transient ischemic attack (TIA) can happen suddenly and be gone in minutes, leaving behind confusion and worry. If you experience stroke symptoms that only last minutes, don’t ignore them! They’re still a sign that you need medical attention right away.

A TIA greatly increases your risk of having a stroke in the next 90 days, and half of the strokes that do follow a TIA happen within the next two days. Getting immediate care can help you avoid a much more serious stroke, potentially saving your life and preventing permanent damage and loss of abilities.