Transient ischaemic attack | Mate rehu ohotata iti

Also called warning stroke or ministroke

Overview
Clinicians
Clinicians

Transient ischaemic attack (TIA or mate rehu ohotata iti) is the same as a stroke, except that the signs last for a short amount of time. TIA is very serious.

A TIA is often called a warning stroke or mini-stroke. It is very serious and shouldn’t be ignored. If treated quickly, the risk of having a stroke can be greatly reduced.

TIA is a medical emergency. Call 111 immediately if you develop any of the following symptoms or warning signs.
Weakness, usually on one side of the face, arm or leg Numbness or pins and needles in the face, arm or leg on one side of the body Slurring of speech or difficulty in finding words can also occur Part or complete loss of vision or blindness in one or both eyes Dizziness or loss of balance or coordination These symptoms usually come on suddenly, and lasts from seconds, or minutes to hours. It does not usually last longer than 24 hours.

TIA is a medical emergency. Call 111 immediately if you develop any of the following symptoms or warning signs.

Weakness, usually on one side of the face, arm or leg
Numbness or pins and needles in the face, arm or leg on one side of the body
Slurring of speech or difficulty in finding words can also occur
Part or complete loss of vision or blindness in one or both eyes
Dizziness or loss of balance or coordination

These symptoms usually come on suddenly, and lasts from seconds, or minutes to hours. It does not usually last longer than 24 hours.

What causes TIA?

TIA is when blood supply to a part of the brain is temporarily blocked. In most cases, this is caused by a blood clot which develops because of plaque.

Plaque is a buildup of cholesterol-containing fatty deposits in a blood vessel. It can decrease the blood flow through the blood vessel and lead to the development of a clot.

If the blood flow to a blood vessel that supplies your brain or eye is blocked, then the symptoms of TIA occur. The blockage is temporary because the clot either dissolves or moves. After this the blood supply to the brain returns to normal and the signs disappear. Most TIA lasts less than 5 minutes.

You may have more than one TIA, and the signs and symptoms of each may be similar or different depending on which area of the brain is involved.

Image: Stroke Foundation NZ

(Stroke Association, UK, 2014)

Who is at risk of having TIA?

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

Risk factors for TIA & 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.

What are the symptoms of a TIA?

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.

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.

Image credit: Stroke Foundation NZ

It is not possible to tell the difference between TIA and stroke in the early stages, so urgent medical help must be sought if any of the signs and symptoms above are noticed.

Even if the symptoms have stopped before help arrives, you should still go to hospital for assessment. TIA is a warning sign that stroke is going to happen in the near future. Getting checked out gives your medical team the chance to determine the best way to lower the risk of this happening.

If you think you may have had a TIA previously and didn't get it checked out, make an appointment to see your doctor urgently. They will assess whether you need to go to hospital for further assessment.

How is a TIA treated?

Although the symptoms of a TIA go away in a few minutes or hours, you will 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 medication to reduce the risk of blood clots forming such as:

Medication	Description
Anti-platelet treatment	These work by preventing certain types of blood cells (called platelets) from sticking together to make blood clot. This means your blood can flow more easily. Examples include: aspirin clopidogrel dipyridamole
Anticoagulant treatment	If you have irregular heart beat, such as atrial fibrillation, you may be at risk of 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
Medication to lower your blood pressure (antihypertensives)	Raised blood pressure increases your chance of TIA greatly, and lowering blood pressure decreases the likelihood of stroke following TIA.
Medication to lower your cholesterol (statins)	Raised cholesterol increases your chance of TIA, and contributes to the formation of fatty deposits in the blood vessels. Lowering cholesterol decreases the likelihood of stroke following TIA.

Learn more

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

Resources

Support

Phone Healthline for free on 0800 611 116 any time of the day or night for advice on any health issue, no matter how small. In an emergency, phone 111 for an ambulance.

Brochures

What is a TIA (transient ischaemic attack)?

Stroke Foundation of NZ

Apps/Tools

Stroke Riskometer app

Information for healthcare providers on transient ischaemic attack

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Clinical resources

From Transient ischaemic attack – shoot first ask questions later BPAC, NZ, 2011

A transient ischaemic attack (TIA) is a medical emergency due to the high risk that stroke will occur within the next 48 hours.
Aspirin, a statin and an antihypertensive medicine should be given to all patients immediately following a suspected TIA – if they are fully recovered and without contraindications.
All patients with a suspected TIA should have their risk of stroke assessed using the ABCD²tool, and then be referred to secondary care for urgent investigation and treatment (according to local protocols).
As soon as a diagnosis of TIA is confirmed, risk factors should be assessed and a long-term, individualised secondary prevention plan implemented.

Transient ischaemic attack: a medical emergency BPAC, NZ, 2009

Continuing professional development

Stroke and TIA clinical update

(Goodfellow Unit Webinar, NZ, 2020)

Managing common neurological conundrums

(Goodfellow Unit Webinar, 2020)

PHARMAC Seminars

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

(PHARMAC Seminars, 2019)

Podcast

Transient Ischemic Attacks – Alan Barber Goodfellow Unit, 2017
"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."

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: