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Transient ischaemic attack: Treatment, symptoms, advice and help

About transient ischaemic attack

Transient ischaemic attack is a stroke in which symptoms resolve within 24 hours. The term TIA traditionally also includes patients with transient monocular blindness (also known as amauros fugax), usually due to a vascular occlusion in the retina.

Transient ischaemic attack: Incidence, age and sex

TIA occurs in about 150,000 patients per year in the United Kingdom.6 The population incidence likely mirrors that of stroke.TIA carries a particularly high short-term risk of stroke, and approximately 15% of diagnosed strokes are preceded by TIAs.

Signs and symptoms of transient ischaemic attack: Diagnosis

Symptoms vary widely from person to person, depending on the area of the brain involved. The most frequent symptoms include temporary loss of vision (typically amaurosis fugax); difficulty speaking (aphasia); weakness on one side of the body (hemiparesis); and numbness or tingling (paresthesia), usually on one side of the body. Impairment of consciousness is very uncommon. There have been cases where there has been a temporary paralysis of a part of the face and the tongue. The symptoms of a TIA are short lived and usually lasts a few seconds to a few minutes and most symptoms disappear within 60 minutes. Some individuals may have a lingering feeling that something odd happened to the body. Dizziness, lack of coordination or poor balance are also symptoms related to TIA. The symptoms may vary in severity. The diagnosis of a TIA includes a history and a physical exam. There are several radiological tests that are done to evaluate patients who have had a TIA. This includes a CT scan or an MRI of the brain,Ultrasound of the neck, an echocardiogram of the heart. In most cases, the source of atherosclerosis is usually identified with an ultrasound.

Causes and prevention of transient ischaemic attack

The most common cause of a TIA is an embolus that arises from a dislodged atherosclerotic plaque in one of the carotid arteries that occludes an artery in the brain. Other reasons include excessive narrowing of large vessels due to an atherosclerotic plaque and increased blood viscosity due to some blood diseases. TIA is related with other medical conditions like hypertension, heart disease (especially atrial fibrillation), migraine, cigarette smoking, hypercholesterolemia, and diabetes mellitus.

A TIA may be prevented by changes in lifestyle which include avoiding smoking ,cutting down on fats and cholesterol to help reduce plaque buildup, eating a healthy diet composed of fruits and vegetables, limiting sodium in the diet which reduces blood pressure, exercising on a regular basis, limiting alcohol intake, maintaining a normal weight and controlling blood pressure and keeping blood sugars under control.

Transient ischaemic attack: Complications

The main complications are acute stroke and recurrent transient ischaemic attack.

Transient ischaemic attack: Treatment

The mainstay of treatment following acute recovery from a TIA should be to diagnose and treat the underlying cause. The initial treatment is aspirin, second line is clopidogrel, third line is ticlopidine. If TIA is recurrent after aspirin treatment, the combination of aspirin and dipyridamole is needed If the TIA affects an area supplied by the carotid arteries, an ultrasound (TCD) scan may demonstrate carotid stenosis. For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery (carotid endarterectomy) may be recommended. To reduce recurrence of an attack , ACE inhibitors are used.