Transient Ischemic Attack (TIA)

What is transient ischemic attack (TIA)?

A transient ischemic attack (TIA) is a brief loss in brain function. It happens when the brain does not get enough blood because blood flow is blocked or decreased for a short time. The symptoms go away when the blood flow becomes normal again. TIA may be caused by anything that blocks blood flow to part of the brain for a short time. Blood flow is most often blocked or decreased by a blood clot. Blood clots can be caused by:

• Fatty deposits called plaque that build up in blood vessels and make them narrower. Pieces of plaque may break off from the wall of a blood vessel and form clots that can block blood flow to the brain, causing a TIA.
• Small blood clots moving to the brain from the heart. For example, people with an abnormal heart rhythm or a mechanical heart valve may form clots in the heart.
• A heart attack

You are more likely to have a TIA or stroke if you have a medical condition that puts a strain on your heart and blood vessels such as:

• High blood pressure
• Diabetes or metabolic syndrome
• High cholesterol
• Blood vessel disease
• Heart rhythm or heart valve problems
• Sickle cell anemia
• Sleep apnea

Some unhealthy lifestyle habits can increase your risk for a TIA or stroke. You are more likely to have a stroke if you:

• Smoke
• Eat an unhealthy diet
• Are overweight
• Don't get enough exercise
• Use illegal drugs or too much alcohol

Your risk is also greater if you have had a TIA or stroke before.

What can I expect in the hospital?

It is important to treat the problem that caused the TIA. Treatment for a TIA may prevent a stroke.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• A heart (cardiac) monitor may be used to check your heartbeat.
• Your blood oxygen level will be monitored by a sensor that is attached to your finger or earlobe.
• Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
• You may have a small tube (catheter) placed into your bladder to drain and measure urine.

Testing

Testing may include:

• Blood tests to check for blood cell levels, fats in the blood, and how well the blood clots
• Neurologic examination: Testing to check your strength, sensation, balance, reflexes, thinking, and memory. Some parts of this test may be repeated many times a day while you are in the hospital.
• Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the brain.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the brain.
• Carotid ultrasound scan: Sound waves and their echoes are passed through your body from a small device that is held against your skin to create pictures of the inside of the arteries in the neck.
• Cerebral arteriogram (also called cerebral angiogram): A series of X-rays is taken after your healthcare provider places a long, thin, flexible tube (catheter) into a blood vessel in your groin or neck and injects contrast dye into your blood vessels to look for areas where the dye may be leaking out of a blood vessel or blocked blood vessels.
• An ECG (also called an EKG or electrocardiogram) is a painless test that shows the electrical activity of the heart.
• Echocardiogram: Sound waves and their echoes are passed through your body from a small device that is held against your skin to create pictures of your heart.

Treatment

The treatment for TIA depends on its cause, your symptoms, how well you respond to treatment, your overall health, and any complications you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face.
• Your provider may prescribe medicines to:
  • Prevent blood clots by thinning your blood
  • Control cholesterol levels
  • Treat other conditions that may have been a risk factor for your TIA, such as high blood pressure or diabetes
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may need surgery to treat TIA. Surgery may include:
  • Angioplasty: A procedure in which your healthcare provider inserts a flexible tube called a balloon catheter into a blood vessel and moves it up to the blocked blood vessel in the neck. The balloon is inflated to widen the artery and improve blood flow to the brain. A metal mesh device called a stent is usually left in the artery to help keep the blood vessel open.
  • Carotid endarterectomy: Surgery to remove plaque that is blocking blood flow in a narrowed artery in the neck, called the carotid artery. The carotid artery supplies blood to the brain.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Trouble speaking or understanding
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Loss of bowel or bladder control
  • Severe headache
  • Seizures or convulsions
  • Loss of balance or coordination
  • Confusion
  • Personality changes
  • Dizziness or lightheadedness
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, the treatment you need, and how well you recover. Talk with your provider about how long your stay may be.