TIA as a stroke harbinger

TIA as a stroke harbingeringer

The symptoms of a TIA are similar to those of a stroke (apoplexy), but the symptoms disappear entirely within a certain period. As with a stroke, the cause is usually a blood clot that blocks a small vessel in the brain. Like a stroke, a TIA is an emergency, so if you notice any symptoms, you should call the emergency services immediately, even if the symptoms have subsided. In addition, a TIA is an important warning signal because the risk of a stroke is significantly increased after a TIA.

Definition of a TIA

TIA stands for Transient Ischemic Attack. Doctors understand this to mean a temporary lack of blood flow (ischemia) in areas of the brain, which manifests itself in the symptoms of a stroke. According to the earlier definition, one spoke of a TIA when the symptoms did not last longer than 24 hours.

According to the current definition of TIA, the symptoms must disappear entirely after a maximum of one hour. Otherwise, the disease is considered a stroke. In addition, an MRI of the skull is necessary for the diagnosis. According to the definition, in contrast to a stroke, there are no signs of blood flow-related damage to areas of the brain in the MRI in a TIA.

An attack in which symptoms last between 24 hours and seven days was formerly called prolonged reversible ischemic neurological deficit (PRIND) or minor stroke. However, these terms for an “intermediate stage” of stroke and TIA are now obsolete since it is assumed that these cases are already “real” strokes.


TIA: Symptoms similar to those of a stroke

In principle, the symptoms of a TIA cannot be distinguished from the signs of a stroke, but they can sometimes be less pronounced. That is why many affected people do not take them seriously at first or recognize them too late.

A TIA can manifest itself through the following symptoms, which usually appear suddenly:

  • blindness lasting a few seconds to minutes or severe deterioration of vision in one eye (amaurosis fugax)
  • Paralysis: Half of the body, half of the face or just one extremity can be affected – typical are a drooping corner of the mouth or difficulty walking
  • Motor disorders, such as difficulty performing simple movements
  • Sensory disturbances such as numbness, tingling or a “furry” feeling
  • Hearing disorders such as tinnitus
  • muscle twitches
  • Speech disorders such as slurred speech, difficulty formulating complete sentences or finding words
  • Language comprehension disorders
  • dizziness or balance problems
  • Loss of consciousness, confusion or personality changes

The symptoms usually appear from one moment to the next.

Blood clots and migraines are possible causes.

In a TIA, certain brain areas are temporarily deprived of oxygen due to poor blood flow. The cause is often a blood clot that blocks a small vessel.

The clot often comes from a plaque that has formed in the carotid artery as part of the hardening of the arteries (arteriosclerosis). Rarely, in the case of heart diseases such as atrial fibrillation, a blood clot can be carried from the heart into a cerebral vessel (cardiac embolism).

A TIA can also occur as part of a migraine: a spasmodic constriction of a blood vessel (vascular spasm) causes a circulatory disorder in the brain.


MRI for diagnostics

In the case of a TIA, you must describe the symptoms as precisely as possible, even if they are of concise duration. You should also tell him about possible previous illnesses – for example, coronary heart disease or atrial fibrillation.

An MRI of the skull is usually performed: It provides information about the extent and location of the insufficient blood flow. Blood flow-related damage to the brain tissue can also be detected – in this case, according to the definition, there is no TIA but a stroke.

Under certain circumstances, further examinations may be necessary for the diagnosis:

  • CT of the skull to rule out bleeding
  • Ultrasound of the vessels (duplex or Doppler sonography)
  • Visualization of the cerebral vessels in an X-ray examination with a contrast medium (digital subtraction angiography)
  • Holter and heart ultrasound to determine possible heart disease as a source of a blood clot
  • 24-hour blood pressure measurement
  • Determination of blood lipid levels

Anticoagulant treatment

If possible, those affected with a TIA should be monitored in a so-called stroke unit – a special ward for stroke patients – for at least 24 hours. Therapy with anticoagulant drugs is usually started to prevent further blood clots from forming.

The active acetylsalicylic acid (ASA) is given as an infusion first. Alternatively, clopidogrel can also be used. Recent studies have also shown that a combination of ASA and clopidogrel can significantly reduce the risk of a stroke following a TIA. Therefore, both active ingredients are often used as part of the therapy. The first studies also point to the same effect when ASA and the active ingredient ticagrelor are used in combination. With combined therapy, however, there may be a slightly increased tendency to bleed.

As a rule, treatment with ASA or clopidogrel in tablet form must be continued permanently. In the case of atrial fibrillation, therapy with an anticoagulant such as Marcumar® may be necessary in addition to or as an alternative.

Increased stroke risk

After a TIA, the risk of a stroke is significantly higher: up to 30 per cent of patients suffer a stroke within five years.

However, the risk can be significantly reduced with appropriate therapy and other preventive measures. Therefore, the necessary diagnostics and treatment are initiated as quickly as possible in the event of a TIA.


ABCD2 score for risk assessment

The risk of a stroke can be estimated using the so-called ABCD2 score. Points are awarded for the following risk factors:

  • A page of a person over 60 years
  • Blood pressure higher than 140/90 mmHg
  • Notable symptoms ( clinic): Hemiplegia or speech disorders
  • duration of symptoms
  • Diabetes mellitus as a pre-existing condition

Points are awarded based on the criteria of “existing” and “absent” and the severity of the symptoms potentially present. Depending on the score, the risk of suffering a stroke within two days after a TIA is up to eight per cent.

TIA prevention: Minimize risk factors

In addition to therapy with anticoagulant drugs, other risk factors must be minimized after a TIA to prevent a stroke. This includes, for example, the treatment of high blood pressure (arterial hypertension) and the optimal adjustment of blood sugar levels in diabetes mellitus.

In addition, the LDL cholesterol should be lowered below 100 mg/dl, for which a blood fat-lowering drug (statin) is usually prescribed. Arteriosclerosis with severe carotid artery narrowing may require surgery to remove plaque to prevent new blood clots from forming.

Change lifestyle – prevent stroke

With a healthy lifestyle, you can do a lot to reduce your risk of stroke:

  • Give up smoking: Nicotine consumption promotes the development of arteriosclerosis.
  • Make sure you exercise regularly: Sport has a positive effect on blood pressure and blood lipids.
  • Reduce your alcohol consumption: Alcohol can increase the risk of stroke.
  • Aim for an average weight: Being overweight favours the development of risk factors for cardiovascular diseases.
  • A healthy and varied diet also has a positive effect overall.



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