# transient ischemic attack | Symptoms, Causes, Tests and Treatment | OSANG > TIA is also called ‘mini-stroke’ and is a strong precursor to cerebral infarction. The risk of stroke occurring within 90 days after a TIA is approximately 10-15%, with… - Official page: https://osns.co.kr/en/encyclopedia/transient-ischemic-attack - Organization: OSANG Neurosurgery ## Page content Stroke ## transient ischemic attack Transient Ischemic Attack · G45.9 Transient ischemic attack (TIA) is a condition in which neurological symptoms due to local ischemia of the brain, spinal cord, or retina appear temporarily and completely disappear within 24 hours (usually within 1 hour), and no tissue infarction is identified. ## At a glance TIA is also called ‘mini-stroke’ and is a strong precursor to cerebral infarction. The risk of stroke occurring within 90 days after a TIA is approximately 10-15%, with half of these occurring within the first 48 hours. Even if symptoms temporarily disappear, emergency evaluation and treatment of the cause are required immediately. Antiplatelet drugs, anticoagulants, and vascular risk factor management are the key to preventing stroke. - 01Definition and Overview - 02Causes and Mechanisms - 03symptoms - 04diagnosis - 05Treatment and Prevention ## Definition and Overview Transient ischemic attack (TIA) is a condition in which neurological deficit symptoms appear temporarily and disappear completely due to local ischemia of the brain, spinal cord, or retina. In modern definitions, it is limited to cases without tissue infarction. In the past, TIA was defined if symptoms disappeared within 24 hours, but if infarction was confirmed on MRI diffusion-weighted imaging (DWI), it was classified as cerebral infarction regardless of symptom duration. TIA is a strong precursor to cerebral infarction. The incidence of stroke within 90 days after a TIA is approximately 10-15%, with half of this risk occurring within the first 48 hours. Therefore, TIA is a neurological emergency requiring immediate medical evaluation. ## Causes and Mechanisms ### Thromboembolic mechanism The most common cause of TIA is temporary vascular occlusion by an atherosclerotic thrombus. Symptoms disappear when blood clots or emboli formed in the carotid artery, aorta, and heart temporarily block cerebral blood vessels and then naturally dissolve and blood flow is restored. The main causes are as follows: - Large vessel atherosclerosis: carotid artery stenosis, intracranial artery stenosis - Cardiogenic embolism: atrial fibrillation, blood clots after myocardial infarction, heart valve disease - Small vessel disease: Cerebral small vessel disease caused by high blood pressure and diabetes - Other: coagulopathy, arterial dissection, vasculitis ### hemodynamic mechanism When there is a sudden drop in blood pressure, orthostatic hypotension, or decreased cardiac output, the ability to automatically regulate cerebral blood flow is reduced, resulting in ischemia. ## symptoms Symptoms of TIA vary depending on the area of ischemia, and last for several minutes to tens of minutes before fully recovering. ### Anterior circulation (carotid system) symptoms - Unilateral limb paralysis or numbness - Speech impairment: slurred speech (dysarthria), inability to speak or understand (aphasia) - Temporary loss of vision in one eye (transient monocular blindness, amaurosis fugax) ### Posterior Circulation (Vertebral Basilar Artery System) Symptoms - Double vision (seeing double) - Bilateral limb weakness - Balance disorders and gait ataxia - severe dizziness - dysphagia ## diagnosis ### ABCD2 Risk Score The ABCD2 score is used to rapidly assess early stroke risk after TIA. - A(Age): Age ≥ 60 years → 1 point - B (Blood pressure): Systolic ≥ 140 or diastolic ≥ 90 mmHg → 1 point - C (Clinical features): Hemiparesis → 2 points, dysarthria (without paralysis) → 1 point - D (Duration): Symptoms persist ≥ 60 minutes → 2 points, 10~59 minutes → 1 point - D (Diabetes): Diabetes → 1 point 0~3 points: low risk, 4~5 points: moderate risk, 6~7 points: high risk ### imaging test - Brain MRI (including DWI): essential to confirm the presence of infarction, more sensitive than CT - Carotid ultrasound and MRA/CTA: assessment of carotid artery stenosis and intracranial vessels. - Cardiac tests: electrocardiogram, echocardiogram (evaluate causes of cardiogenic emboli) - Blood tests: CBC, coagulation tests, fasting blood sugar, lipid panel ## Treatment and Prevention ### first aid As soon as a TIA occurs, visit the emergency room and undergo a brain MRI, blood vessel examination, and heart examination. The EXPRESS study found that immediate access to a specialized TIA treatment clinic reduced stroke rates by approximately 80% within 90 days. ### antithrombotic treatment - Antiplatelet agents: In non-cardiogenic TIA, aspirin ± clopidogrel dual antiplatelet therapy is administered for a short period of time. - Anticoagulants: If psychogenic causes such as atrial fibrillation are confirmed, NOAC or warfarin treatment is started. ### Risk factor management - Hypertension: Target systolic blood pressure below 130 mmHg - Hyperlipidemia: Statin treatment, goal of LDL cholesterol less than 70 mg/dL - Diabetes: Blood sugar control (HbA1c < 7%) - Carotid artery stenosis: If stenosis is ≥ 70%, consider carotid endarterectomy or stent implantation. ## Frequently asked questions ### Q01My TIA symptoms have gone away, but do I really need to go to the emergency room? You must visit the emergency room immediately. The risk of stroke occurring within 48 hours after a TIA is highest, and prompt evaluation and initiation of treatment are critical to preventing stroke. According to the UK's EXPRESS study, the incidence of stroke within 90 days was reduced by 80% in patients who received immediate specialist treatment after TIA. ### Q02What are the symptoms of TIA? Typical symptoms include sudden unilateral limb paralysis or paresthesia, speech problems (slurring), language comprehension difficulties, sudden loss of vision in one eye (transient monocular vision loss), double vision (double vision), balance problems and gait abnormalities, and sudden severe headaches. Even if symptoms disappear within a few minutes, it may be a TIA. ### Q03What is the difference between TIA and stroke? Stroke causes permanent ischemic damage (infarction) to brain tissue and neurological symptoms persist. TIA is a condition in which symptoms recover naturally after temporary blockage of blood flow, symptoms disappear completely within 24 hours, and no infarction is confirmed on brain MRI. However, the modern definition of TIA includes imaging findings, and if a small infarct is found on a DWI sequence, it is classified as a cerebral infarction. ### Q04Can I drive after a TIA? After a TIA, it is recommended to refrain from driving for a certain period of time. Most countries, including Korea, recommend refraining from driving for at least 1 month (sometimes 3 months) after a TIA. For high-risk occupations such as aircraft piloting, stricter standards apply. ### Q05What should I do on a daily basis to prevent TIA? Active drug treatment for hypertension, diabetes, and hyperlipidemia is primarily important. Smoking cessation, maintaining an appropriate weight, regular exercise, and moderation lower vascular risk factors. If you have atrial fibrillation, anticoagulant treatment is necessary. A specialist decides whether to take antiplatelet drugs (aspirin, clopidogrel) depending on the cause. ## Related articles - carotid artery stenosis - cerebral infarction - brain aneurysm - stroke This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.