What Is a Transient Ischemic Attack (TIA)?
A transient ischemic attack (TIA) is similar to a stroke. Your blood delivers oxygen to every part of your body, and your cells need it to survive. If your blood flow gets blocked, it can cause a TIA.
When you have a TIA, the flow of blood to part of your brain gets cut off for just a few minutes. A TIA is also sometimes called a ministroke, but don't let the "mini" part fool you. A TIA can be a sign that a full-blown stroke is on the way. About 1 in 5 people who have a TIA have a stroke within 90 days. And 2 in 5 people who think they've had a TIA actually had a stroke.
If you have symptoms of a TIA or stroke, call 911 or go to the emergency room. It's important to have a medical evaluation within an hour, if possible.
TIA Symptoms
The symptoms of a TIA can happen suddenly. They're similar to early stroke symptoms, but only last from a few minutes up to about a day. They include:
Droopy face. Your eyes or mouth may droop on one side. You may also have trouble smiling.
Speaking problems. Your speech may be slurred, garbled, or hard to understand. It might be difficult to find the right words.
Weak or numb arms. You may have trouble lifting and holding up both arms.
Those are the most obvious symptoms, but you may also notice:
- Balance and coordination problems
- Blindness or blurred vision in one or both eyes
- Not being able to move one side of your body
- Confusion and a hard time understanding others
- Dizziness
- A sudden, severe headache
- Trouble swallowing
You can have more than one TIA. Each can have different symptoms, based on which part of your brain is affected.
Post-TIA symptoms
After a TIA, you might notice some long-term effects. Since these could impact your work or other daily activities, you may want to tell your employer and loved ones about it.
TIA lasting effects can include:
Fatigue. You can get very tired after a TIA. Fatigue is when your sleepiness is extreme but doesn't get better with rest.
Emotional shifts. After you have a TIA, you might feel shocked or anxious about your well-being. It's important to talk to your friends and family about your anxiety, to help your overall mood. Sharing your feelings can help others better understand what you're going through. Regular exercise can also help get rid of some tension and boost your energy.
If you continue to have physical, memory, or thinking troubles after a TIA, talk to your doctor.
TIA Causes
A TIA can happen when a blood clot gets lodged in an artery that supplies blood to your brain. Without regular blood flow, your brain is starved for oxygen and can't work the way it normally does.
That's why you get symptoms like muscle weakness or slurred speech with a TIA. It's like having a clogged fuel line in your car. Your engine can't run if it's not getting gas.
Clots form when you have a buildup of a fatty, waxy substance called plaque in your arteries. A clot can take shape anywhere in your body, and float along until it gets stuck somewhere. If that "somewhere" happens to be an artery that goes to your brain, you can have a TIA.
You can also get a TIA if there's so much plaque in an artery that it severely limits blood flow to your brain, just like a clot.
TIA Diagnosis
If you have symptoms of a TIA, it's important to see your doctor right away. A quick diagnosis is important, because it helps figure out what caused your TIA, how your doctor should treat it, and your risk of having a full-blown stroke.
Your doctor might use:
Physical and neurological exams. They'll test your vision, eye movement, speech, language, reflexes, strength, and sensory system. They might also listen to your carotid artery, which is in your neck, using a stethoscope. This will tell your doctor if you have hardening of the arteries. Your doctor may also use an ophthalmoscope to check for fragments of cholesterol or platelets in the blood vessels at the back of your eyes.
Your doctor will also look for other stroke risk factors like high cholesterol, high blood pressure, diabetes, or high homocysteine (an amino acid that can signal low levels of B vitamins and/or heart disease).
Computerized tomography (CT) or computerized tomography angiography (CTA) scans. These use X-rays to make a 3D image of the brain, along with the arteries in your neck and brain.
Carotid ultrasonography. If your doctor thinks your carotid artery caused your TIA, they'll use this tool to look closely at any narrowing or clotting in your neck. An ultrasound uses high-frequency sound waves to create images of the arteries that will show clots.
Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). These tests use a magnetic field to help your doctor check your brain, arteries, and neck. With an MRA, your doctor will inject a contrast material into your blood vessel to get a better image of your arteries.
Echocardiography. This tool allows your doctor to look clearly at possible causes, like blood clots, through an ultrasound image. This is used to see if the cause of your TIA might be an issue with your heart.
Arteriography. This helps your doctor look at arteries in your brain that usually aren't seen on an X-ray. Your doctor will put a thin tube (catheter) in a small cut in your leg. The tube is moved to the brain, where it injects dye to get a better view of the brain on an X-ray.
TIA Treatment
After you have a TIA, the goal of treatment is to lower your risk of a having a stroke in the future. Your doctor will decide on your treatment based on what caused the TIA. Treatment will depend on things like the location of the clot, how serious the TIA was, and findings of an MRI or CT scan.
TIA medications
Your doctor will likely recommend medication for you after a TIA. Medications are prescribed to treat the cause of the TIA and prevent a stroke.
Anti-platelet drugs. Aspirin is the most commonly recommended medication after a TIA because it is inexpensive, you can get it over the counter, and it has few side effects. Other anti-platelet medications that your doctor may prescribe include clopidogrel (Plavix), ticagrelor (Brilinta), and Aggrenox (a combination of aspirin and dipyridamole). Your doctor may recommend you take aspirin and one of these medications for a short time after your TIA to reduce the risk of a stroke. Anti-platelet drugs make platelets less sticky, so they won't clump together and form blood clots.
Anticoagulant drugs. Your doctor may prescribe one of these medications. They thin your blood, making it less likely to clot. Blood thinners are usually prescribed if you had a blood clot in your heart or have a condition known as atrial fibrillation (irregular heart rhythm). Anticoagulants include apixaban (Eliquis), dabigatran (Pradaxa), heparin, rivaroxaban (Xarelto), and warfarin (Coumadin, Jantoven).
Statins. Statins are medications used for lowering cholesterol. Research has also shown that statins may help keep blood vessels healthy and hinder blood clotting. Statins include atorvastatin (Lipitor), fluvastin (Lescol XL), rosuvastatin (Crestor), and simvastatin (Zocor).
Blood pressure medications. Your doctor may prescribe one of these medications, which help expand blood vessels and allow for better blood flow. There are several medications in this class, including calcium channel blockers like amlodipine (Norvasc), angiotensin-converting enzyme (ACE) inhibitors like benazepril (Lotensin), angiotensin II receptor blockers (ARBs) including candesartan (Atacand), and diuretics.
Your doctor may also recommend an endovascular procedure (which means inside a blood vessel). With these, a narrow tube is inserted into a vessel through a small cut, usually in your groin. These procedures include:
- Thrombectomy, performed to remove a blood clot
- Stent, a mesh device put into a narrowed blood vessel to keep it open
- Angioplasty, where a catheter is used to place a balloon in a vessel to widen it
If medication and endovascular procedures aren't enough, your doctor may recommend surgery. If one of the carotid arteries in your neck is narrowed or blocked, your doctor may perform surgery to clear it out and restore normal blood flow. One option is an operation called a carotid endarterectomy, where your doctor opens up your carotid artery, scrapes out the plaque, and closes it back up.
TIA Complications
If you have a TIA, you are more likely to have a heart event or other conditions not related to your heart shortly afterward. In fact, you are more likely to have some kind of complication as soon as 30 days after your TIA. Possible complications include:
Stroke. You have about a 3% chance of having a stroke after a TIA, and they happen more frequently within 30 days.
Acute coronary syndrome. Having a TIA also increases your risk of having chest pain or a heart attack within 30 days.
Ventricular arrhythmia. A fast heartbeat because of unusual electrical activity is also more common after a TIA.
Blood clot. You are more likely to have another blood clot, including deep vein thrombosis, where you have a blood clot in a deep vein, after a TIA.
Acute heart failure. After a TIA, your risk goes up within 90 days.
Non-cardiovascular complications
Having a TIA also increases your risk of other conditions, including depression, problems swallowing, urinary tract infections, and falls.
TIA Recovery
Although symptoms of a TIA only last for a short period of time, you may have some lasting effects from a TIA. Your doctor can help you understand the best plan to keep you healthy and prevent complications after you have a TIA.
Avoid driving. Your doctor will probably tell you not to drive for 1 month after having a TIA. If you have had a full recovery after 1 month, your doctor should allow you to get back behind the wheel.
Go to follow-ups. Go to all of your follow-up appointments your doctor schedules and take any medications they prescribe regularly.
Avoid getting sick. Try to avoid getting colds and the flu by taking vaccines that are right for you, including those for the flu, pneumonia, and COVID-19.
Focus on your health. It's important to follow treatment advice from your doctor and consider healthy lifestyle changes. If you smoke, stop or enroll in smoking cessation classes; drink less alcohol or none at all; eat a balanced diet, including plenty of fruits and vegetables, whole grains, and lean meats; and try to get 150 minutes of physical activity each week. All of these things can help lower your risk of a stroke.
Manage depression. Depression, apathy, and anxiety can last for a year or more after a TIA. These feelings can be due to changes in the brain from the TIA or from the emotional trauma of having a major health event. Symptoms to watch for include:
- An anxious mood
- Feeling sad or empty
- Unusual crankiness
- Feeling hopeless or helpless
- Loss of interest in things that are normally enjoyable for you
- Unusual fatigue
- Sleeping changes, including sleeping too much or too little
- A hard time concentrating
Managing your depression or anxiety can increase your chances of a healthy recovery. If you feel like you may be dealing with either condition, talk to your doctor about treatment options.
TIA Prevention
To prevent a TIA, make these healthy lifestyle choices:
Eat food that's good for you. Choose whole foods, meaning those that are as natural and unprocessed as possible. Also eat a low-fat, low-salt, high-fiber diet with plenty of fruits and veggies. Limit saturated fats and sugar , and avoid trans fats.
Get a good night's sleep. Regular shut-eye can lower your risk of a stroke. Create a routine to relax at night and try to get the recommended 7-9 hours of sleep each night. If you have sleep apnea – where your breathing stops frequently during the night before quickly restarting – talk to your doctor about getting the condition treated.
Limit alcohol. If you drink, keep it to one drink a day if you're female, or two if you're male.
Manage your other health conditions. The more you control issues like high blood pressure, diabetes, and atrial fibrillation, the better.
Stick to an exercise routine. Typically, you need at least 150 minutes of medium-level cardio, like brisk walking, each week. Check with your doctor to see what's safe for you.
Stay at a healthy weight. If you are unsure of what weight is best for you, a good range is a body mass index of 18.5 to 24.9. (For example, a person who is 5 feet, 9 inches tall could weigh from 125 to 168 pounds and be in this range.) Another measure to take could be waist size. For men or people assigned male at birth (AMAB), waist circumference should be 40 inches or less. For women or people assigned female at birth (AFAB), waist size should be 35 inches or less. This will help with your blood pressure and cholesterol, too.
Stop smoking. Tobacco harms your health in many ways, including raising your stroke risk.
Avoid illegal drugs. Drugs like amphetamines, cocaine, and heroin can raise your chances of a TIA or stroke.
Along with other lifestyle changes, if you're a biological woman, you should take a few more steps to avoid a TIA or stroke. For instance, if you're over age 75, ask your doctor to check you for atrial fibrillation.
If you're pregnant, have your blood pressure checked regularly during and after pregnancy.
If you think you might start birth control pills, get checked for high blood pressure first.
If you get migraines with auras, it's even more important that you stop smoking right away.
TIA vs. Stroke
TIAs are similar to ischemic strokes, which are also caused by blood clots.
The main difference is that a TIA only lasts a few minutes. Then, chemicals in your body quickly break down the clot or it gets pushed along, like a temporary clog in a pipe. Normal blood flow returns to your brain without causing permanent damage. Symptoms, which are similar to the those of a stroke, can last for up to 24 hours, but they're usually gone in an hour.
Strokes, on the other hand, don't go away so quickly. That means some part of your brain goes without oxygen, and the longer that lasts, the more damage happens. While a TIA comes on, goes away, and leaves no symptoms, a stroke can have long-lasting effects and can be life-threatening.
TIA Risk Factors
A TIA can affect anyone. The same things that raise your odds of having a stroke also affect your risk of a TIA, and there are a lot of issues in play.
Risks you can't control. Some things you can't change, but it's helpful to be aware of them:
- Age. The odds of a TIA or stroke get much higher when you're over 55. After age 55, your risk of having a stroke doubles every 10 years.
- Family history .If one of your grandparents, parents, or a brother or sister had a stroke, you have a greater chance of getting a TIA.
- Previous TIA. Once you've had one, you're much more likely to get another.
- Race. Black people, as well as people who are Pacific Islanders, have a higher chance of a TIA than other ethnic groups.
- Gender. Women have a greater risk of strokes and TIAs than men.
Health conditions. Other medical problems you have can also increase the odds of having a TIA, including:
- Being overweight
- Carotid artery disease, where the main arteries from your heart to your brain are narrowed or clogged
- Diabetes
- Heart disease, including heart defects and rhythm problems like atrial fibrillation (AFib)
- High blood pressure
- High cholesterol
- Peripheral artery disease (PAD), where arteries in your arms or legs get blocked
- Sickle cell disease, a genetic condition where misshaped blood cells can get wedged into arteries more easily
- COVID-19
Lifestyle. Some of the choices you make every day may affect your chances of having a TIA. You may have a higher risk if you:
- Drink a lot of alcohol (more than one drink per day for women and people AFAB; more than two drinks daily for men and people AMAB)
- Don't get enough exercise (150 minutes of moderate-intensity activity each week)
- Eat too many foods high in cholesterol, saturated fats, trans fats, and salt, and not enough fruits, veggies, and fiber
- Smoke
- Use drugs such as amphetamines, cocaine, and heroin
Risks for women. Odds of a TIA may be higher for women who:
- Are pregnant, since pregnancy can raise your blood pressure and make your heart work harder
- Get migraines with auras
- Take birth control pills, especially if you smoke or have high blood pressure
- Use hormone replacement therapy (HRT) to treat menopause symptoms
TIA Takeaways
A TIA is also called a ministroke because it usually only lasts for several minutes. But it's important to get medical help right away if you have stroke symptoms. A TIA is often a warning sign of a full-blown stroke.
TIA FAQs
Is A TIA life-threatening? No, but it can mean you are more likely to have a stroke in the near future. If you have symptoms, call 911 or go to the emergency room.
What is the life expectancy after having a TIA? A TIA doesn't do any long-term damage to your brain or cause permanent disability.
What happens if a ministroke goes untreated? You will be more likely to have more ministrokes or an ischemic stroke in the future.