Ischemia is reduced or blocked blood flow to the tissue, due to a clot or narrowing of the arteries. Symptoms may last less than five minutes.
However, a TIA is a warning shot across the bow that needs to be taken very seriously. It may portend life-threatening or debilitating complications that can be prevented with a combination of medications and lifestyle modifications.
TIA is significantly underdiagnosed. Symptoms can be as understated as the onset of double vision or may include facial or limb weakness on one side, slurred speech or problems comprehending others, dizziness or difficulty balancing or blindness in one or both eyes. TIA incidence increases with age.
What is a TIA?
It is a brief episode of neurological dysfunction caused by focal brain ischemia or retinal ischemia (low blood flow in the back of the eye) without evidence of tissue death.
In other words, TIA has a rapid onset with potential to cause temporary muscle weakness, creating difficulty in activities such as walking, speaking and swallowing, as well as dizziness and double vision.
Though they are temporary, TIA complications include increased risk of stroke to heightened depressive risk to even death. Despite the seriousness of TIAs, patients or caregivers often delay receiving treatment.
After a TIA, stroke risk goes up dramatically. Even within the first 24 hours, stroke risk can be 5 percent. According to one study, the incidence of stroke is 11 percent after seven days. Even worse, over the long term, the probability that a patient will experience a stroke reaches approximately 30 percent after five years.
The EXPRESS study, a population-based study that considered the effect of urgent treatment of TIA and minor stroke on recurrent stroke, evaluated 1,287 patients, comparing their initial treatment times after experiencing a TIA or minor stroke and their subsequent outcomes.
The Phase 1 cohort was assessed within a median of three days of symptoms and received a first prescription within 20 days. In Phase 2, median delays for assessment and first prescription were less than one day.
All patients were followed for two years after treatment. Phase 2 patients had significantly improved outcomes over the Phase 1 patients. Ninety-day stroke risk was reduced from 10 percent to 2 percent, an 80 percent improvement.
The moral of the story is treat a TIA as a stroke should be treated; the faster the diagnosis and treatment, the lower the likelihood of complications.
In a study of over 5,000 participants, TIA was associated with an almost 2.5-times increased risk of depressive disorder. Those who had multiple TIAs had a higher likelihood. Unlike with stroke, in TIA it takes much longer to diagnose depression, about three years after the event.
What can you do?
Awareness and education are important. While 67 percent of stroke patients receive education about their condition, only 35 percent of TIA patients do. Many risk factors are potentially modifiable, with high blood pressure being at the top of the list, as well as high cholesterol and diabetes.
Secondary prevention (preventing recurrence) and prevention of complications are similar to those of stroke protocols. Medications may include aspirin, antiplatelets and anticoagulants.
Lifestyle modifications include a Mediterranean and DASH diet combination. Patients should not start an aspirin regimen for chronic preventive use without the guidance of a physician.
If you or someone you know has TIA symptoms, the patient needs to see a neurologist and a primary care physician and/or a cardiologist immediately for assessment and treatment to reduce risk of stroke and other long-term effects.