DESCRIPTION

• 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: ministroke

EPIDEMIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

Temporary reduction/cessation of cerebral blood flow adversely affecting neuronal function; common subtypes:

• Embolic from unknown source (36%)
• Cardioembolic events (29%):
  • Valvular pathology; mural hypokinesia with thrombosis.
  • Atrial fibrillation (5–20% incidence)
• Large artery atherothrombosis (16%)
• Small vessel ischemic diseases (16%)
• Uncommon causes (3%): arterial dissection, hypercoagulable states, vasculitis, vasospasms, or sickle cell occlusive disease

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

• Strict control of DM, HTN, hyperlipidemia
• Anticoagulation when high risk of cardioembolism (e.g., atrial fibrillation, mechanical valves)
• Antiplatelet therapy for preventing recurrence, if previous TIA (2)

Geriatric Considerations

• Older patients have a higher mortality rate—highest in 7th and 8th decades of life.
• Atrial fibrillation is a frequent cause.

Pediatric Considerations

• Congenital heart disease is a common cause.
• Genetic: Marfan syndrome, moyamoya, or sickle cell disease

Pregnancy Considerations

• Preeclampsia, eclampsia, and HELLP syndrome
• Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome
• 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)