Transient Ischemic Attack

Symptoms

The possible symptoms of a transient ischemic attack (TIA) include:

  • Visual disturbances, temporary blindness
  • Difficulty swallowing
  • Sensory disturbances such as numbness or formication.
  • Speech disorders
  • Coordination disorders, loss of balance, paralysis.
  • Behavioral disturbances, fatigue, drowsiness, agitation, psychosis, memory impairment.

The symptoms occur suddenly, are transient and last only briefly, during a maximum of one hour. After a transient ischemic attack, the risk of stroke is greatly increased, which can lead to disability and death. The condition is common. For example, at least 3500 cases per year are expected in many countries and 500,000 or more in the United States.

Causes

A transient ischemic attack is a sudden, brief neurologic disturbance caused by an undersupply of blood and oxygen to an area of the brain. The retina of the eye can also be affected. In contrast to stroke, no infarction, i.e. no tissue destruction, is observed. It is caused by an interruption of the blood flow due to a blood clot in the supplying vessels. This either forms locally or is washed up from another organ (embolism). Common sites of origin are the internal carotid artery and the heart.

Diagnosis

Diagnosis is made as an inpatient under medical care. After admission, numerous diagnostic tests are performed to clarify the condition and causes of the disease (e.g., vital signs, ECG, EEG, echocardiography, blood work, MRI, MRA, CT, CTA). Possible differential diagnoses include migraine, glucose metabolism disorders (hypoglycemia), convulsions (epileptic seizure), and tumors.

Treatment

A transient ischemic attack is a medical emergency. Patients should be admitted to a hospital emergency department as soon as possible. This is partly because of the increased risk of stroke and partly because it is not possible to assess with certainty what the actual condition is. Acute drug treatment includes administration of fibrinolytics such as alteplase (Actilyse) to dissolve a blood clot or platelet aggregation inhibitors such as acetylsalicylic acid (Aspirin) to “thin the blood.” Acetylsalicylic acid is given at a higher dose (300 mg) or intravenously to start. Surgical procedures such as carotid endarterectomy are also indicated in some cases of severe narrowing of the blood vessels.

Secondary Prevention

The goal of secondary prevention is to reduce the risk of subsequent stroke with behavioral recommendations and medications. The following conditions and risk factors are addressed:

  • High blood pressure – important factor
  • Disturbances of the lipid metabolism
  • Cardiovascular diseases, cardiac arrhythmias, especially atrial fibrillation, which can lead to cerebral embolism
  • Atherosclerosis
  • Smoking
  • Overweight, malnutrition
  • Physical inactivity
  • Diabetes mellitus
  • Excessive alcohol consumption
  • Illegal intoxicants

Acetylsalicylic acid (Aspirin cardio, generics) is commonly used to “thin the blood.” In addition, other antithrombotics such as clopidogrel (Plavix, generics) and dipyridamole (Asasantin) and in some cases anticoagulants are available. Furthermore, antihypertensive agents and statins such as atorvastatin (Sortis, generic) are used, among others.

Recommendations

  • Normalization of blood pressure, blood glucose and lipid levels.
  • Do not smoke
  • Healthy diet
  • Sufficient physical exercise
  • Restrained alcohol consumption (no more than 1 glass per day).
  • Aim for normal weight (BMI less than 25)
  • Do not consume illegal intoxicants