In transient ischemic attack (TIA) – colloquially called mini-stroke – (synonyms: Amaurosis fugax; amnestic episode; TIA; transient ischemic attack (TIA) ; transient ischemic attack (TIA); cerebral intermittent claudication; cerebral intermittent ischemia; cerebral ischemic attack; cerebral transient ischemia; ICD-10 G45.-: Cerebral transient ischemia and related syndromes) is a sudden disturbance of blood flow to the brain that results in neurological dysfunction that resolves within 24 hours and is thus the only distinction from apoplexy (stroke). This makes it clear that a TIA is an emergency that must be treated as quickly as possible.
Causes for a stroke and thus also for a TIA are various diseases that have an effect on the blood supply to the brain. One way of classifying the causes is:
- Cerebral infarcts – occlusion of an artery in the brain.
- Intracerebral hemorrhage (ICB) – bleeding in the brain.
- Subarachnoid hemorrhage (SAB) – bleeding between the meninges.
- Cerebral venous thrombosis – formation of blood clots in the veins of the brain.
Peak incidence: the disease occurs predominantly in older age (> 60 years).
The incidence (frequency of new cases) is about 5 diseases per 1,000 inhabitants per year (in Switzerland). The number of unreported cases is probably higher.
Course and prognosis: In the acute stage of a TIA, no distinction can be made between TIA and apoplexy. The therapy is based on the procedure in apoplexy. Caution: TIA is often a harbinger of apoplexy! The risk of apoplexy within the first seven days after a TIA was 5.2% in one study with a 95% confidence interval between 3.9% and 6.5%. The lowest risk, 1%, was found in studies in which patients with TIA were admitted to a stroke unit. The highest risk was found in studies in which TIA was not immediately evaluated and treated. In 15-26%, TIA precedes apoplexy as a warning symptom. Based on this knowledge, effective secondary prevention should be initiated early. This should also be done in the case of a TIA if no complications have occurred in the first 90 days after the event. According to one study, for the collective of those who had no complications in the first 90 days after the event, the mortality risk is twice that of patients with early complications. For the primary endpoints of deaths, myocardial infarctions (heart attacks), and apoplectic strokes (strokes), after one, three, and even after 5 years, the risk was twice as high if there were no complications after the first 90 days after the event.
Transient ischemic attack often occurs recurrently (recurrently). One year after the occurrence of a TIA, the outcome of major fatal and nonfatal cardiovascular events was 6.2% and the risk of apoplexy (stroke) was 5.1%.
Note: Intracerebral hemorrhage (ICB; cerebral hemorrhage) was present in 1.24% of patients with suspected TIA.
