Transient Ischemic Attack (TIA)

How to Know if Someone Is at Risk for a Ministroke
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What is a TIA (ministroke)?

A transient ischemic attack (TIA) -- also called a "ministroke" -- is a brief episode of stroke symptoms caused by low blood flow in arteries within the brain. Unlike an actual stroke, a TIA doesn't result in permanent brain damage, and the symptoms clear up completely. TIAs used to be defined as stroke symptoms that disappeared in less than 24 hours, but the 24-hour specification is no longer part of the definition. TIA symptoms can last from minutes to hours.

TIAs are strong predictors of future stroke: 4 to 10 percent of people develop a true stroke within 48 hours of a TIA, and many others develop strokes within the following three months. So although it may be tempting to ignore a TIA once the symptoms disappear, the attack should be considered an important warning sign that a full-blown stroke may be on the horizon. Stroke risk after TIA is especially high in people who are older than 60, have diabetes, and/or have blood pressure higher than 140/90.

Fortunately, prompt medical evaluation (within 24 hours) of TIAs usually does lead to treatment that reduces stroke risk. Medical evaluation is also needed to properly identify the cause of stroke-like symptoms, since other conditions, such as migraine and seizure, can also cause them.

How TIAs and Strokes Happen

Ischemic strokes and TIAs occur when a vessel carrying blood to the brain becomes blocked, causing the blood flow to a particular area to slow or stop. This usually happens in one of three ways:

  • A blood clot forms in a blood vessel in the brain and blocks the vessel.
  • A blood clot that formed elsewhere in the body breaks loose and travels to the brain, blocking a vessel.
  • A major or minor artery carrying blood to the brain becomes nearly blocked over time, often due to atherosclerosis (buildup of plaque). This causes chronic low blood flow. A further drop in blood flow can then cause a TIA or even a stroke.

In a TIA, the symptoms disappear because blood flow is restored before the brain suffers serious, permanent damage. But even though the symptoms don't linger, some brain injury may have occurred. When a person has multiple small strokes, the damage may add up to vascular dementia: a progressive loss of memory, judgment, and the ability to think and communicate. That's why it's so important that TIAs be taken seriously and treated appropriately.

Signs and Symptoms of a TIA, and What to Do

The symptoms of TIA and ischemic stroke are the same. As with a stroke, the symptoms depend on the area of the brain affected. Your family member probably won't experience all of the symptoms associated with a TIA. And even if she had a TIA or stroke earlier, a second TIA might not cause the same symptoms.

Here's a list of the warning signs of a TIA or ischemic stroke. For more detailed information about stroke, see How to Tell if Your Parent Is Having a Stroke: Signs to Look Out for and What to Do. Call 911 right away if you notice any of these signs:

  • Sudden numbness or weakness of the face, arm, or leg -- especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden difficulty walking, loss of balance or coordination, dizziness

If someone experiences any of the above symptoms for even the briefest amount of time, call 911 immediately. Make a note of the exact time when the symptoms began. This information can be extremely helpful to the emergency room personnel.

Even if you suspect the symptoms are caused by a TIA rather than a stroke, don't wait to see whether the symptoms go away. If it's a stroke, the person needs emergency medical care immediately. If it's a TIA, the doctor needs to evaluate her, treat the cause of the TIA, and then set up a plan to prevent a future stroke.

Your family member or friend may not want to seek treatment for a TIA, especially if the symptoms disappear quickly. She may brush it off as aches and pains, hunger, fatigue, or just old age. But even if she's very persuasive, don't let her talk you out of seeking medical attention, since there's a high risk of stroke in the 24 to 48 hours immediately following a TIA.

If she didn't tell you about the TIA right away or managed to persuade you not to call 911, it's not too late. Call the doctor as soon as possible to make sure your family member gets the treatment she needs.

What to Expect From the Doctor After a TIA

The doctor will focus on two separate issues: First, what caused the episode, and second, how to treat the cause and prevent future strokes.

  1. Determine the cause of the TIA. Whether a patient goes to the emergency room or schedules an appointment after the TIA, the doctor will probably do one or more of the following:
  • Check the patient's blood pressure to make sure it's within normal range
  • Order a carotid ultrasound to see whether the carotid artery is blocked
  • Test for atrial fibrillation, a condition that can cause blood clots to form in the heart
  • Schedule a CT or MRI scan to look for brain injury
  • Schedule a special CT or MRI to look for narrowing of the arteries in the brain
  • Check for heart disease
  • Check cholesterol levels

  1. Treat the cause and prevent future strokes. The type of treatment the doctor recommends will depend on the cause of the TIA. The doctor may prescribe medication to control blood pressure, lower cholesterol, or slow blood clotting. If tests reveal a blockage in the carotid artery, your friend or family member may need to undergo a procedure to remove the blockage or increase blood flow. Regardless of how the TIA is treated, the patient will need to take steps to prevent a future stroke, including quitting smoking if applicable. The doctor will help you and her come up with a plan to reduce the risk. For other practical tips, see 10 Ways to Help Your Parent Prevent a Stroke.

Although a TIA and the possibility of a stroke may leave you feeling overwhelmed and frightened, there's actually a bright side: You and your family member have been given the gift of a wake-up call. By seeking medical advice, getting the appropriate treatment, and making lifestyle changes, your family member may be able to avoid a serious stroke.

Stephanie Trelogan

Stephanie Trelogan writes about heart disease, stroke, and depression issues that concern people caring for their aging parents. See full bio

over 2 years, said...

Please give me information for my husband on what it's like after stroke. He doesn't understand why I can't focus on but one task at a time. HELP Thank you, Karen in South Carolina

about 3 years, said...

you tell the reason, what are the symptoms??

over 3 years, said...

Unless I missed it I didn't see what the symtons of mini strokes are?

over 3 years, said...

A very well written article! I m a Registred Nurse, but it is helpful to review or learn new information in a short, yet detailed article. I found very useful the tips on how to talk with the doctor, and what he/she might look for. The only complaint I have is not about the articles, but the advertising! I understand it is what pays for the website, but this is way too much! I only just joined the site, and want to scream if I see one more Assisted living advertisement! I think it may insult some folks who have come to this site for help, and are overwhelmed with the ads aimed at seniors with more money.

about 4 years, said...

how do you know that you are having a real heart attack or just bad pains in your cheast milam

over 4 years, said...

All the information in the article was useful

almost 5 years, said...

What is the difference if any, between a stroke caused by low or blocked blood flow, and a Thalamic Stroke caused by a lesion from MS that damages the Thalamus on the left hemisphere? I know the results of the damage from the Thalamic stroke. It is known to be the Dejerine"“Roussy syndrome. What is the prognosis or treatment, for this syndrome?

almost 5 years, said...

Interested in homes that accept Medicare/Medicare

almost 5 years, said...

very helpful

almost 5 years, said...

I had two mini strokes but because I have no insurance my doctor ordered no tests and basically did nothing even though I have high blood pressure and diabetes with a history of stroke and heart attack in my family. I wonder how many people die because of no insurance?

almost 5 years, said...

my spouse was 48- had 6 weeks of constant headache, worsening episodes of dizziness, tingling lips, flashing lights, double vision. We paid for a CT scan ourselves- it was normal. He collapsed and I called an ambulance. He was treated at ED for migraine. I asked if he could have a stroke. They said he was too young. 3 days later he collapsed. Into ED in ambulance again. Treated for brain infection- he couldn't move or speak properly. He began having seizures. The next morning they finally did the MRI i had asked for 3 days before. He had had a massive stroke. He is now a quadreplegic.

over 5 years, said...

In July 2012 I had four TIA's in three days. After many tests, the only reason that could be found for them was that I was severely de-hydrated. I have had Atrial Fib since 1994 and have had my right Carotid Artery opened and cleaned out twice. The second time because of Staph infection after the first surgery. Fortunately, I have good doctors that have kept me alive and well. I will be 85 years old in April 2013.

over 5 years, said...

I have not had the experience of taking my mother-in-law to the emergency room with what I suspected was a TIA and gotten the response of all the tests screening for a TIA that was "over." Not every emergency room recognizes dizziness, unsteadiness, etc. as suggestive "enough" of a TIA to order carotid test, MRI, fibrulation test...they did not -- even though I told them I thought it was a TIA. They said dizziness, unsteadiness, momentary mumbling were not unusual in a woman her age -- and found nothing in BP unusual. My MIL had a fatal stroke 6 weeks later. I believe if the emergency room staff--and her own doctor--had treated her for a TIA earlier (which I think she had and they did not recognize or treat), she would still be alive. I was later told by several friends that not all TIAs leave any evidence that they have happened...and nothing shows up on tests. Numbness or paralysis on one side...these definitely got attention and tests. Unsteadiness, dizziness, mumbling upon awakening...these do not always receive much attention at all. And this is in a major city with famous teaching hospital. None of us can understand why we are told to take someone to the ER for identification and treatment of a TIA to head off a stroke...why doesn't this happen??? Why are doctors and ERs shrugging this off as "nothing," sending them home (embarrassed!) and then shortly thereafter the person has a stroke? Please address this if you can...I know my friends and I are hardly the only family members who took our loved ones to the hospital with suspected TIAs, whose loved ones received no advance tests, and subsequently in a few weeks or a month or two had a stroke. Thanks!

over 5 years, said...

On page one it was written TIAs cause no permanent damage. On page 2 it is then written that brain injury may occur and lead to vascular dementia.

over 5 years, said...

Go to the ER in a hospital next time that occurs, and ask them for their advice. there are agencies that can help you medically even without ins....Good luck..

over 5 years, said...

My husband had a few mini strokes,we dont know when he had them, the reason we found out because he started to walk unbalance and falling down. He had a MRI done. Hes having trouble with his memory, will his memory get better in time? He's taking donepesil.

over 5 years, said...

Yes it was helpful, as I've had a TIA and now I better understand it. Thank You for a very good article. ;-)

over 6 years, said...

Thanks for the info for stroke patient and how to avoid it, very helpful thanks much.

over 6 years, said...

nice to have such useful info about health,thank you

over 6 years, said...

details on stroke prevention

over 6 years, said...

Look forward to more informative articles.

almost 7 years, said...


almost 7 years, said...

Hello ROSE A, Thank you very much for your question. Unfortunately, we are unable to diagnose medical problems for our site members, or provide medical guidance online. While members of our community may respond to your question, we recommend that you contact a doctor offline regarding this medical issue. Take care -- Emily | Community Manager

almost 7 years, said...

Been worried about my right eye. 1 or 2x a day my eye will close all the way for maybe 30 mins. Vision will get blury @ times.Every time this happens Im tired & take a nap. Does any one have a suggestion for me?The ins Im on will not pay for another exam, only once a yr. Can not afford to see eye Dr. Like many people, just dont have money, just enough for landlord & groc. Would love to get any advice. Also get a slight head ache. Thank you