Transient ischemic attacks

Signs and Symptoms

A person may have the following signs and symptoms during a TIA:

• Blurred vision in both eyes, brief blindness, or double vision
• Slurred or garbled speech
• Weakness, sometimes on only one side of the body
• Vertigo (a whirling or spinning feeling)
• Strange sensations, such as burning or tingling
• Trouble with coordination and balance
• Loss of consciousness
• Temporary memory problems
• Headache
• Confusion

What Causes It?

TIAs are usually caused by a clot that blocks blood flow. Plaque, often called atherosclerosis, can build up in your arteries, narrowing the space blood flows through or causing a clot to develop. Some other conditions that can cause TIAs include:

• A weakened, bulging heart wall (ventricular aneurysm)
• A rapid, irregular heartbeat (atrial fibrillation)
• Narrowing of the main artery in your neck, the carotid artery
• Blood clotting problems

Who is Most At Risk?

These characteristics increase your risk for TIA:

• Over 55 years of age
• Male
• Family history of TIA
• African-American or Japanese-American
• High blood pressure
• High cholesterol
• Heart disease
• History of stroke
• Diabetes
• Smoking
• Heavy alcohol consumption
• Lack of regular physical exercise
• Obesity
• Sleep apnea
• Hypothyroidism

What to Expect at Your Provider's Office

If you have symptoms of TIA, see your health care provider right away. DO NOT wait for your symptoms to get better.

Your provider will ask about your symptoms, examine you, and may do tests, such as blood tests, computed tomography (CT) scan or magnetic resonance imaging (MRI) of your head, or ultrasound of the blood vessels to your brain. If the ultrasound shows some blockage, your doctor may consider a test called an angiogram to view the blood vessels more clearly.

These tests will help your provider determine whether you had a TIA or something else, and what the cause may have been.

Treatment Options

Prevention

You can take the following steps to help prevent TIA:

• DO NOT smoke.
• Exercise regularly.
• Eat a healthy diet with lots of fruits, vegetables, and whole grains, and maintain a healthy weight.
• DO NOT drink alcohol excessively. Limit yourself to no more than one drink a day if you are a woman; two drinks a day if you are a man.
• Work with your health care provider to control high blood pressure, high cholesterol, or diabetes.
• Work with your provider to treat carotid artery disease, coronary artery disease, irregular heartbeat, congestive heart failure, or heart valve disease.
• Sleep for 6 to 9 hours each night.

Treatment Plan

Treatment will depend on your signs and symptoms, exams, and tests. Your provider may admit you to the hospital to evaluate your condition more thoroughly and to treat you if your condition becomes worse. You may need oxygen to help you breathe and to lessen the effects of blocked blood flow.

Drug Therapies

To help prevent TIA, stroke, or heart attack, your provider may prescribe antiplatelet agents, drugs that prevent platelets from clumping; or anticoagulants (blood thinners), drugs that prevent blood from clotting. Many drugs, herbs, and dietary supplements interact with these types of medications. Talk to your doctor and pharmacist. These drugs include:

• Low-dose aspirin
• Ticlopidine (Ticlid)
• Clopidogrel (Plavix)
• Dipyridamole and aspirin (Aggrenox)
• Warfarin (Coumadin)

Surgical and Other Procedures

If your carotid (neck) artery is narrowed, your provider may recommend a type of surgery called carotid endarterectomy to clean deposits from inside the artery. While examining your carotid artery, your provider may perform angioplasty, where a balloon or a tube-like structure called a stent is inserted into the artery to open it.

Complementary and Alternative Therapies

If you think you are having a TIA, or a stroke, call 911. If you have had a TIA or are at risk for one, ask your doctor before taking any herbs or supplements. This is especially important if you take any drugs to prevent blood clots.

Diet is very important in preventing and treating blood vessel (vascular) diseases. Some nutrients and herbs may protect against injury from reduced blood flow and damage from oxidation, a process that happens as the body ages and damages cells, tissue, and DNA. Research shows mindfulness-based interventions also help improve outcomes.

Following these tips for a healthy diet and lifestyle may help lower your risk of TIA and stroke:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Studies show that people who eat diets high in fruits and vegetables have a lower risk of stroke.
• Eat foods high in B-vitamins and potassium, such as almonds, beans, whole grains (if no allergy is present), green leafy vegetables (such as spinach and kale), papayas, cantaloupe, and bananas.
• Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed. One study found that women who ate more than one whole grain food each day had a lower risk of stroke than women who ate almost no whole grains.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present), or beans for protein.
• Use healthy cooking oils, such as olive oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and tobacco.
• Lower your salt intake.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Foods that are high in these nutrients may help prevent stroke. There is no evidence that taking supplements will help, however:

• Potassium. Found in bananas, beets, Brussels sprouts, canteloupe, milk, orange juice.
• Magnesium. Found in whole grains, green leafy vegetables such as spinach, nuts, dry beans, and peas.
• Fish oil. Eating a moderate amount of fish seems to protect against stroke, however people who eat more than 46g of fish per day seem to have a higher risk of stroke.
• Calcium, in women, found in dairy products, sardines, spinach.

In scientific studies, these supplements have shown promise for treating stroke or TIA:

• Glycine, an amino acid. One study found that giving people glycine under the tongue within 6 hours of an acute ischemic stroke may help protect the brain.
• Citicoline, a chemical in your brain that was made into a supplement to treat stroke in Japan. One study found that people who were given citicoline within 24 hours of an acute ischemic stroke had a better recovery in 3 months than people who were given placebo.
• Alpha-GPC, a chemical made from soy and other plants. One study found that people given alpha GPC after a stroke or TIA might have better mental function than those who were given placebo. The study used intramuscular injections for 28 days, followed by oral alpha GPC for 6 months. Alpha GPC may interact with scopalamine, a drug that treats motion sickness.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis). One study found that drinking 3 or more cups of green tea per day lowered the risk of dying from a heart attack or any reason. Some evidence suggested that lower death rates were due in part to avoiding stroke. Use caffeine-free products.
• Danshen (Salvia bowleyana). Early research suggests that danshen may help people recover brain function better after an ischemic stroke. More research needs to be done. Danshen may interact with many medications. People who take digoxin (Lanoxin) or blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix), should not take danshen.
• Ginkgo (Ginkgo biloba). Some studies suggest that people who take ginkgo after a stroke do better than those who do not, but other studies found no difference between ginkgo and placebo. If you are taking blood-thinning medications, talk to your doctor before taking ginkgo. Ginkgo increases the risk of bleeding, which can be dangerous for someone taking blood thinners, such as aspirin or warfarin (Coumadin). Ginkgo may not be appropriate for people who are trying to become pregnant, or for people who have a history of seizures.
• Garlic (Allium sativum) may slightly reduce high blood pressure and lower risk of atherosclerosis, which can cause TIAs. Garlic may increase the risk of bleeding, which can be dangerous for someone taking blood thinners, such as aspirin or warfarin (Coumadin). If you are taking blood-thinning medications, talk to your doctor before taking garlic. Garlic may also interact with some HIV medications and with birth control pills.

Scientific literature does not support the use of homeopathy for TIAs. An experienced homeopath would consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.

Prognosis/Possible Complications

The shorter the amount of time between TIAs, the more likely you are to have a stroke. This seems to be the most important predictor of stroke risk. Narrowing of the carotid arteries also indicates risk of a stroke. How long symptoms last does not seem to be connected to stroke risk.

TIAs are a warning sign of stroke. But more people with TIA die from heart attack than stroke. If you have a stroke and are not treated right away, you may be more likely to have complications, such as pneumonia, hypothermia, dehydration, or serious skeletal muscle problems. Damage to the brain may lead to breathing problems. Bleeding or swelling in the head may occur days after a stroke. Multiple strokes increase the risk of seizure, blood clots to the legs or lungs, and impaired memory or judgment (dementia).

Following Up

Follow your health care provider's advice on getting checkups after a TIA to prevent stroke and heart attack. About one-third of people who have a TIA will have an acute stroke at some time in the future. Half of these strokes occur within a year, and 20% happen within 5 months.

Supporting Research

Albucher JF, Martel P. Transient ischemic stroke. Rev Pract. 2006;56(13):1409-15.

Bangalore S, Schwamm L, Smith EE, et al. Secondary prevention after ischemic stroke or transient ischemic attack. Am J Med. 2014;127(8):728-38.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Carillo-Vico A, Reiter RJ, Lardone PJ, et al. The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs. 2006;7(5):423-31.

Diener HC. What should be done after the first TIA? MMW Fortschr Med. 2007;149 Suppl 2:46, 48-49.

Ferri: Ferri's Clinical Advisor 2015. 1st ed. Philadelphia, PA: Elsevier Mosby; 2014.

Iso H, Rexrode KM, Stampfer MJ, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA. 2001;285:304-12.

Jagoda A. Transient ischemic attack overview; defining the challenges for improving outcomes. Ann Emerg Med. 2008;52(2):S3-6.

Jiu-Chiuan C, et al. Sleep duration and risk of ischemic stroke in postmenopausal women. Stroke. July, 2008 (published online).

Kuriyama S, Shimazu T, Ohmori K, et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all-cause mortality. JAMA. 2006;296:1255-65.

Kwak SM, Myung SK, Lee YJ, Seo HG; for the Korean Meta-analysis Study Group. Efficacy of Omega-3 Fatty Acid Supplements (Eicosapentaenoic Acid and Docosahexaenoic Acid) in the Secondary Prevention of Cardiovascular Disease: A Meta-analysis of Randomized, Double-blind, Placebo-Controlled Trials. Arch Intern Med. 2012 Apr 9. [Epub ahead of print]

Lavallee P, Amarenco P. TIA clinic: a major advance in management of transient ischemic attacks. Front Neurol Neurosci. 2014; 33:30-40.

Lawrence M, Booth J, Mercer S, Crawford E. A systemic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8(6):465-74

Lewandowski CA. Transient ischemic attack: definitions and clinical presentations. Ann Emerg Med. 2008;52(2):S7-16.

Lund C, Dahl A, Russell D. Transitory ischemic attack. Tidsskr Nor Laegeforen. 2007;127(7):900-2.

New policosanol product combines natural cholesterol lowering with omega-3 fatty acids to lower CV risk. Cardiovasc J S Afr. 2006;17(2):92.

Pokan R, Hofmann P, von Duvillard SP, et al. Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients. Br J Sports Med. 2006;40(9):773-8.

Remmel KS, Wanahita A, Moore K, Gruenthal M. Acute ischemic stroke and hypothyroidism. J Ky Med Assoc. 2006;104(5):191-3.

Ronning OM. How to diagnose acute stroke? Tidsskr Nor Laegeforen. 2007;127(7):888-91.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Shi J, Yu J, Pohorly JE, Kakuda Y. Polyphenolics in grape seeds-biochemistry and functionality. J Med Food. 2003;6(4):291-9.

Siegel D, Neiders T. Vertebral artery dissection and pontine infarct after chiropractic manipulation. Am J Emerg Med. 2001;19(2):171-172.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Spence JD. Secondary stroke prevention. Nat Rev Neurol. 2010 Sep;6(9):477-86. Epub 2010 Aug 10. Review.

VITATOPS Trial Study Group. B vitamins in patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial. Lancet Neurol. 2010 Sep;9(9):855-65. Epub 2010 Aug 3.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Xie J, Zeng Q, Wang L. The protective effect of L-carnitine on ischemia-reperfusion heart. J Huazhong Univ Sci Technolog Med Sci. 2006;26(2):188-91.

Yochum LA, Folsom AR, Kushi LH. Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women. Am J Clin Nutr. 2000;72:476-83.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Zeng X, Liu M, Yang Y, et al. Ginkgo biloba for acute ischaemic stroke. Cochrane Database Syst Rev. 2005;(4):CD003691.