Transient Ischemic Attack (TIA)
Basics
Description
- A transient episode of neurologic dysfunction due to focal brain, retinal, or spinal cord ischemia without acute infarction
- 7.5–17.4% of patients with transient ischemic attack (TIA) experience a stroke within 3 months (1).
- Synonym(s): ministroke
Epidemiology
Prevalence
- Prevalence of TIA in general population: ~2%
- Risk increases >60 years of age; highest in 7th and 8th decades of life
- Predominant sex: male > female
- Predominant race/ethnicity: African Americans > Hispanics > Caucasians
Etiology and Pathophysiology
Temporary reduction/cessation of cerebral blood flow adversely affecting neuronal function
- Carotid/vertebral atherosclerotic disease (artery-to-artery thromboembolism, low-flow ischemia)
- Lacunar infarcts: small, deep vessel disease associated with hypertension (HTN) and diabetes mellitus (DM)
- Embolism secondary to the following:
- Valvular (mitral valve) pathology
- Mural hypokinesias/akinesias with thrombosis (acute anterior MI/congestive cardiomyopathies)
- Cardiac arrhythmia (atrial fibrillation accounts for 5–20% incidence)
- Hypercoagulable states (antiphospholipid antibodies, increased estrogen [e.g., oral contraceptives], pregnancy and parturition)
- Arteritis (vasculitis)
- Sympathomimetic drugs (e.g., cocaine)
- Other causes: spontaneous and posttraumatic (e.g., chiropractic manipulation) arterial dissection
- Fibromuscular dysplasia
Genetics
Inheritance is polygenic, with tendency to clustering of risk factors within families.
Risk Factors
- Older age (i.e., >60 years old)
- HTN, cardiac diseases (atrial fibrillation, MI, valvular disease)
- Atherosclerotic disease (carotid/vertebral stenosis)
- Obesity, DM, hyperlipidemia
- Cigarette smoking
- Thrombophilias
General Prevention
- Control of medical risk factors: DM, HTN, hyperlipidemia
- Anticoagulation when high risk of cardioembolism (e.g., atrial fibrillation, mechanical valves)
- Blood pressure (BP) control, with antiplatelet therapy for preventing recurrence if previous TIA (2)
ALERT
1.5–3.5% risk of stroke in first 48 hours after TIA
1.5–3.5% risk of stroke in first 48 hours after TIA
Geriatric Considerations
- Older patients have a higher mortality rate—highest in 7th and 8th decades of life.
- Atrial fibrillation is a frequent cause among the elderly.
Pediatric Considerations
- Congenital heart disease is a common cause among pediatric patients.
- Genetic: Marfan syndrome, moyamoya, or sickle cell disease
Pregnancy Considerations
- Preeclampsia, eclampsia, and HELLP syndrome
- Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome
- Postpartum angiopathy
- Cerebral venous thrombosis
- Hypercoagulable states related to pregnancy
Commonly Associated Conditions
- Atrial fibrillation, uncontrolled HTN
- Carotid stenosis
- Some disease processes mimic TIA presentation (seizures, migraines, metabolic disturbances, syncope, multiple sclerosis); difference: gradual onset with nonspecific symptoms (headache, memory loss) versus acute onset with specific neurologic deficits (TIA)
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Citation
Domino, Frank J., et al., editors. "Transient Ischemic Attack (TIA)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688263/all/Transient_Ischemic_Attack__TIA_.
Transient Ischemic Attack (TIA). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688263/all/Transient_Ischemic_Attack__TIA_. Accessed September 7, 2024.
Transient Ischemic Attack (TIA). (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688263/all/Transient_Ischemic_Attack__TIA_
Transient Ischemic Attack (TIA) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 September 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688263/all/Transient_Ischemic_Attack__TIA_.
* Article titles in AMA citation format should be in sentence-case
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T1 - Transient Ischemic Attack (TIA)
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ED - Baldor,Robert A,
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BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688263/all/Transient_Ischemic_Attack__TIA_
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DB - Medicine Central
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