Transient Ischemic Attack
(TIA, Mini-Stroke)
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Daniel
Kulick, MD, FACC, FSCAI, and William C. Shiel Jr., MD, FACP, FACR
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Transient Ischemic Attack (TIA) Symptoms: A Trip to the ER
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 The event
A 73 year old woman is vacuuming when her left leg becomes weak and she has
difficulty standing. Her face and left arm become numb. She calls for her
husband, who helps her to a chair, and even though the symptoms resolve within
five minutes, they decide to go to the hospital. In the hospital parking lot,
they debate whether they should go into the Emergency Department or just turn
around and go home.
This woman has suffered a TIA, or transient ischemic attack, which is
basically a stroke that
resolves on its own. Since the right side of the brain controls
the left side of the body (and vice versa), she suffered reversible damage to
her right brain and that caused her left leg to get weak and also developed
numbness on the left side.
After some discussion, the woman decides she wants to seek medical care, and
she and her husband walk through the Emergency Department doors. The doctor and
nurse take a medical history to find out what happened. All of the symptoms have
resolved, so the next step is follow-up care. The healthcare team asks the
patient if she has any of the known risk factors for stroke (which are the same
for heart disease):
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What is a transient ischemic attack (TIA)?
The primary role of the brain is to send signals to the body for motor function
and through the five senses (sight, hearing, touch, smell, and taste), to receive signals
and return the appropriate response. The brain processes
information through conscious thought and unconsciously through nerve systems
that control basic bodily functions, like heart rate, temperature control and
balance.
For the most part, the brain is arranged so that the right side of the brain
controls the left side of the body and the left side of the brain controls the
right of the body. Vision is located in the back of the brain (occiput) and
balance and
coordination is located at the bottom of the brain (cerebellum). Blood supply to
the brain comes from the carotid arteries that are located in the front of the
neck and the vertebral arteries that run in the back of neck through small
canals in the bony spine (vertebrae) of the neck.
When a portion of the brain loses its blood supply, it becomes oxygen
deficient and can become damaged. The part of the body that the brain controls stops
functioning. This is called a stroke or a cerebro-vascular accident (CVA). If
the brain is able to regain its blood supply quickly, then the CVA symptoms may
resolve; this is known as a transient ischemic attack (TIA).
What are the causes of transient ischemic
attack (TIA)?
Loss of blood supply to portions of the brain can occur for a variety of
reasons. A blood vessel can get blocked and blood supply to a part of the brain
is lost, or a blood vessel leaks blood into the brain (brain hemorrhage). Most
commonly, the blood vessel is blocked. The blockage can be caused by a blood
clot that forms in the blood vessel (thrombosis) or it can be caused by a clot
or debris that floats downstream (embolus).
Atherosclerosis or "hardening of the arteries" can cause fatty plaque
formations in he blood vessel wall. The plaque can rupture and causes a small
blood clot to form and occlude the blood vessel. Blockage can also occur when
debris from narrowing of a carotid artery breaks off, and floats downstream to
cause the occlusion. Sometimes, in people with an irregular heart beat called
atrial fibrillation, small blood clots can be formed and travel to the brain to
cause the obstruction.
Picture of
Carotid Artery Disease and Plaque Buildup
Brain hemorrhage or bleeding in the brain can be due to an
aneurysm, a weak
spot in a blood vessel that ruptures and spills blood into the brain tissue, or
it may be due to spontaneous bleeding caused by poorly controlled hypertension
(high blood pressure). Such bleeding more commonly results in a true
stroke (CVA), as
opposed to a TIA.
Next: What are the risk factors for transient ischemic attack (TIA)? »
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