Transient ischaemic attack | Mate rehu ohotata iti

Also called TIA, warning stroke or ministroke

Key points about transient ischaemic attack

  • A transient ischaemic attack (TIA) is called a warning stroke or mini-stroke. It's a medical emergency and shouldn’t be ignored.
  • A TIA happens when the blood supply to part of your brain is cut off by a blood clot. When the blood clot breaks up, the blood supply goes back to normal and the symptoms go away.
  • Symptoms come on suddenly, and last a few seconds up to hours. If it lasts longer than 24 hours then it's a stroke.
  • It's not possible to tell the difference between a TIA and a stroke at the beginning. Strokes can be treated. 
  • Call 111 immediately if you develop any of the symptoms listed below.

 

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The symptoms of a TIA are the same as those of a stroke, but unlike a stroke they only last for a few minutes or hours. It’s not possible to tell the difference at the beginning, so the best thing to do is act as if it is a stroke – call 111.

Like a stroke, the signs and symptoms of a TIA usually begin suddenly.

The main symptoms can be remembered with the word FAST: Face-Arms-Speech-Time.

  • Face – has the face dropped on one side? Is one side of the smile droopy?
  • Arms – can both arms be lifted about the head and kept there, or is one arm weak or numb?
  • Speech – is speech slurred or garbled? 
  • Time – lost time is lost brain. Dial 111 immediately if you notice any of these signs or symptoms.

The video in English below shows the symptoms of a TIA or stroke. Know the signs of stroke. Think FAST: FACE drooping, ARM weakness, SPEECH difficulty, TAKE ACTION to call 111.'

Video: Know the signs of stroke – think FAST (English)

The video may take a few moments to load.

(Ministry of Health, NZ, 2018)

Video: Know the signs of stroke – think FAST (Te reo Māori)

The same video in te reo. Take action – he poto te wā. Waea tonu atu ki 111. Kia pai ai te whakaoranga o te tangata. This video may take a few moments to load.

(Ministry of Health, NZ, 2018)

The word FAST includes the symptoms of most TIAs. A more complete list is:

  • Weakness, usually on one side of the face, arm or leg.
  • Numbness of the face, arm or leg on one side of the bod.
  • Slurring of speech or difficulty in finding words.
  • Part or complete loss of vision, double vision or blindness in one or both eye.
  • Suddenly not being able to walk.
  • Vertigo with one of the other symptoms (vertigo on it’s own is more likely to have another cause).

These symptoms start suddenly, are worst at the start, and mostly last a few minutes. 70% get better completely within an hour.

Video: What exactly is a transient ischemic attack (TIA)? - Penn State Hershey Stroke Center

Note: This video was made in the US so the emergency number is not correct for Aotearoa New Zealand. In an emergency, call 111. This video may take a few moments to load.

(Penn State Health, US, 2013)

A transient ischaemic attack (TIA) happens when the blood supply to part of your brain is cut off by a blood clot. That part of your brain can’t do it’s job and you get symptoms in the part of the body it’s supposed to be controlling.

For example, if it’s the part of your brain that tells your arm to move, you won’t be able to move your arm. If the clot goes to the artery that leads to your eye you won't be able to see out of that eye. When the blood clot breaks up, the blood flows back and you can move your arm, or see, again. If the blood clot doesn’t break up, that part of the brain dies and it’s called a stroke.

Transient means it comes and goes again (or it's temporary), and ischaemic means starved of blood and oxygen.

The carotid and vertebral arteries in your neck are the main blood vessels that take blood from your heart to your brain. Atheroma or plaque can build up inside these arteries. Atheroma is made of fat and cholesterol in the wall of the artery and, as it builds up, it makes them narrower and stiffer. This is also called hardening of the arteries or atherosclerosis.  A blood clot can form on the surface of the plaque. If a piece of blood clot breaks off it gets swept upstream until it gets stuck in a smaller artery in your brain.

Another place blood clots can come from is your heart. If your heart isn’t beating properly, a rhythm problem called atrial fibrillation, blood can stay in your heart too long and clot. The clots can then get swept upstream to your brain.

Little blood clots in your arteries block the blood supply to that part of your brain, so it doesn’t work properly. That's when you get the symptoms of a TIA. Small blood clots usually break up quickly so no permanent damage is done. 

If the blood clot doesn’t break up the brain is starved of oxygen for too long and the brain cells die. This a stroke.

You may have more than one TIA, and the signs and symptoms of each may be similar or different depending on which part of your brain the clot goes to. 

Graphic showing blocked blood supply in brain causing TIA

Image credit: Stroke Foundation NZ

The things that increase your chances of having a TIA are the same as those that increase your risk of stroke. 

Risk factors for TIA and stroke
  • high blood pressure
  • high blood cholesterol
  • diabetes
  • smoking
  • high alcohol intake
  • being overweight or obese
  • atrial fibrillation
  • lack of physical activity
  • family history
  • increasing age

Check your risk with the Stroke Riskometer app developed by the Auckland University of Technology.

If you think you might have had a TIA, contact your healthcare provider. 

  • You'll be examined to check out other possible causes for your symptoms, and to check for signs of what is happening in your brain.
  • You'll have a blood test, have your blood pressure taken and have an ECG.
  • It's not always necessary to have a scan of your head, but this will sometimes be needed if it's not clear what's happening.
  • Your healthcare provider may arrange for you to have an ultrasound of your carotid arteries to check for atherosclerosis. If your arteries are very narrow, surgery called endarterectomy can help prevent future TIAs and strokes.

What if I'm fully recovered or it happened a long time ago?

Even if your symptoms went away in a few minutes it's important that you see a healthcare provider straight away. This is because there's a high chance of having a stroke in the first week after a TIA – especially in the first 2 days. 

If you think you might have had a TIA in the past see your GP or nurse practitioner. It's important to try and stop having a TIA or stroke in the future.

Although the symptoms of a TIA go away in a few minutes or hours, you'll need treatment to help prevent another TIA or a full stroke happening in the future. Your treatment will depend on your individual circumstances, such as your age and medical history. Treatment usually includes medicine to reduce the risk of blood clots forming such as:

Medicine Description
Anti-platelet treatment
  • These work by preventing blood cells called platelets from sticking together to make your blood clot. This means your blood can flow more easily.
  • Examples include:
Anticoagulant treatment
  • If you have irregular heart beat, such as atrial fibrillation, you may be at risk of a TIA because a clot can enter your blood stream from your heart.
  • In this case, you may prescribed an anticoagulant to prevent blood clots from forming and to stop existing clots getting bigger. Read more about anticoagulants.
  • Common anticoagulant medicines include:
    • warfarin 
    • dabigatran
    • rivaroxiban
Antihypertensives to to lower your blood pressure 
  • High blood pressure greatly increases your chance of TIA, and lowering blood pressure decreases the chance of stroke following TIA.
Statins to lower your cholesterol 
  • High cholesterol builds up as plaque in your arteries and increases your chance of TIA. Lowering cholesterol decreases the chance of stroke following TIA.

 

You won't be safe to drive for 1 month after your TIA. This is because of the high risk of having another TIA or stroke while driving.

If you are having a TIA – the best thing you can do to care for yourself is call 111.

If you have already had a TIA – you can lower the risk of having another one, or having a stroke. Take this chance to think about what you can do for your health. This is one of those times when choosing to take medicine really does make a difference to how long you live, and how well you live. 

You can lower your chance of having a TIA or stroke by: 

Many people who have a TIA will go on to have more TIAs. About 1–2 in 10 people who have a TIA have a stroke within the next year. This is much higher than the risk of someone the same age who hasn't had a TIA. About 3 in 100 people will have a heart attack within a year of having a TIA. This is because the risks, and what happens inside the arteries of the heart, are very similar. Taking control of your blood pressure, cholesterol and other risks are the best way to lower the chance of this happening.

Stroke | Mate rehu ohotata
Blood clots (poketoto)

TIA or ministroke(external link) Stroke Foundation, NZ
Transient ischaemic attack(external link) NHS Choices, UK
Transient ischaemic attack – explained(external link) Watch, Learn, Live – Interactive Cardiovascular Library – American Heart Association, US

Resources

Brochures

What is a TIA (transient ischaemic attack)?(external link) Stroke Foundation of NZ

Transient ischaemic attack(external link) NHS, UK

Apps/tools

Stroke Riskometer app

References

TIA guideline(external link) Health New Zealand | Te Whatu Ora Counties Manukau
Transient ischaemic attacks(external link) NHS, UK
TIAs (warning strokes or mini-strokes)(external link) Stroke Foundation, NZ
Transient ischaemic attacks(external link) Patient Info (Doctor), UK

Clinical resources

Transient ischaemic attacks(external link) Patient Info, doctor, UK

Webinars

Video: Stroke and TIA, what's new

This video may take a few moments to load.

(Goodfellow Unit Webinar, NZ, 2020)

Video: Managing common neurological conundrums

This video may take a few moments to load.

(Goodfellow Unit Webinar, NZ, 2020)

PHARMAC Seminars

Video: Interactive cases, neuromuscular and stroke, Dr Anna Ranta – Dr Anna Ranta (36 minutes)

This video may take a few moments to load.

(PHARMAC Seminars, 2019)

Podcast

Transient Ischemic Attacks – Alan Barber(external link) Goodfellow Unit, NZ, 2016 (26 minutes)
Professor Alan Barber talks about the diagnosis and management of transient ischemic attacks in primary care. Alan is lead neurologist for Auckland Hospital Stoke Service and holds the Neurological Foundation of New Zealand Chair in Clinical Neurology at the University of Auckland.

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Reviewed by: Dr Emma Dunning, Clinical Editor and Advisor

Last reviewed:

Read more at: https://healthify.nz/health-a-z/t/transient-ischaemic-attack/
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