TRANSIENT ISCHEMIC ATTACK

Mini Stroke

TIAs are brief temporary strokes that last less than an hour. In reality, most TIAs last less than 5 minutes. Remember that it’s a Transient ISCHEMIC Attack, and not a Transient INFARCTIVE Attack. By definition, there is no infarct - and therefore no permanent damage - following a TIA. 

Why would a stroke only last for 5 minutes?

Most TIAs are caused by a blood clot. Immediately after a clot creates an occlusion, the body starts to break it down. If the clot is small, the body may dissolve the clot before the tissue dies. TIAs are ominous forewarnings of approaching ischemia. Statistically they are one of the strongest predictive factors for having a stroke in the near future. 

How do you diagnose TIAs?

They are a diagnosis of exclusion. By the time the patient presents, the episode will be over. There is no test for TIAs. Once the TIA resolves, the physical exam and radiology will be normal.

So I diagnose a TIA, what next?

This patient is either shooting clots or has nasty atherosclerosis. So scan their body looking for a thrombus. Here’s how:

• Look at their brain. Use an MRI.

• Look at their brain vessels. Get a CT angiography (CTA) or MR angiography (MRA).

• Look at their carotids for stenosis. Use an ultrasound.

• Look at their heart. Use an EKG to rule out afib, and an echo to assess the architecture of the heart. 

Now, treat them to lower the odds of a clot. Give some combination of antiplatelets and anticoagulants (often Aspirin and Plavix).