Transient ischemic attack (TIA)

Alternative names:

little stroke; mini stroke; TIA

Symptoms:

• numbness, tingling, changes in sensation
• weakness, heavy feeling of extremities
• speech difficulty
  • garbled speech
  • slurred speech
  • thick speech

• vision changes
  • loss of vision in one eye
  • decreased vision
  • double vision

• sensation that the person or the room is moving (vertigo)
• loss of balance
• lack of coordination
• gait changes, staggering
• falling (caused by weakness in the legs)

Symptoms that may be confused with TIA but are not usually part of the disorder may include:

• simple changes in consciousness (may be caused by medications or other disorders)
• fainting
• lightheadedness or dizziness by itself
• vertigo by itself
• seizures
• nausea and vomiting (without other symptoms)
• transient amnesia

Additional symptoms that may be associated with this disease:

• facial paralysis
• eye pain
• confusion

Note: Symptoms begin suddenly, last only a short time (from a few minutes to 24 hours) and disappear completely. Symptoms may occur again at a later time. Specific symptoms vary depending on the location (which vessel is involved), the degree of vessel involvement, and the extent of collateral circulation. Symptoms usually occur on the same side of the body if more than one body part is involved.

Signs and tests:

A detailed and complete history is vital to the diagnosis, because the specific deficits demonstrated correspond well with the specific lesion or affected area of the brain. For example, involvement of one arm or leg may indicate damage to one brain artery, while involvement of both legs or arms may indicate damage to a different artery.

Physical examination may include neurologic examination, which may be abnormal during an episode but normal after the episode has passed. It may also be used to rule out a stroke in evolution rather than TIA. The eyes may be examined, including a check of the pressures within the eye. Blood pressure may be high. Auscultation with a stethoscope over the carotid or other artery may show a bruit, an abnormal sound caused by irregular blood flow, which may indicate atherosclerotic plaque or a thrombus in the area.

Tests for TIA may include tests to determine the cause, extent of blood vessel involvement, and to rule out stroke or other disorder that may cause the symptoms.

• CBC and PT tests are used to rule out hematologic disease.
• Head CT scan or cranial MRI are used to rule out focal lesions as the cause of symptoms.
• A carotid duplex (ultrasound) may be performed if there is suspected carotid stenosis.
• A cerebral arteriogram may be performed if there is suspected localized vascular (blood vessel) disease, such as carotid artery stenosis ("hardening") or stenosis of arteries in the brain.

Other tests and procedures may be performed to determine underlying disorders and to rule out other disorders that may cause the symptoms. This may include examination for hypertension, heart disease, diabetes, high blood lipids, and peripheral vascular disease. These tests and procedures may include:

• blood glucose
• blood chemistry
• serum lipids
• tests for syphilis
• ECG
• chest X-ray
• echocardiography (if heart disorder is suspected)