Slides Transient Ischemic Attack

Transient Ischemic Attacks
Neurological disorders
With Rhonda Lawes
MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

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TIA
Caused by interruption Most TIAs last less than one Risk of permanent tissue injury
of blood flow to a local hour; TIAs that last longer are (i.e. infarction) even when focal
portion of the brain most often associated with transient neurologic symptoms
brain infarction last less than one hour
Relatively brief ischemia can cause permanent brain injury.

TIA = Medical Emergency
TIAs are a warning sign and patients should

seek immediate medical treatment. One in 3
patients will progress to ischemic stroke.

TIA
Usually last a short period of time (< 24 hours)
Neurologic symptoms present
Focal brain, spinal cord, or retinal ischemia
No infarction of tissue
Symptoms vary based on location of ischemia

Ischemic Stroke
Neurologic symptoms
Infarcted CNS tissue
Symptoms vary based on size and location of infarct
Neurologic deficits remain longer than TIA

TIA vs. Ischemic Stroke
TIA Ischemic stroke

Usually last a short period of time Neurologic deficits remain longer
(> 24 hours) than TIA
Neurologic symptoms present Neurologic symptoms present
No infarction of tissue Infarcted CNS tissue
Symptoms vary based on location Symptoms vary based on size

of ischemia and location of infarct
Focal brain, spinal cord, or retinal

ischemia

Other Transient Neurologic Events
TIA is one cause of these events. Other common causes that will
be ruled out include seizure, migraine aura and syncope.
Less common but possible causes:
• Hypoglycemia • Cerebral amyloid • Nerve root compression

angiopathy
• Multiple sclerosis • Peripheral
• Various toxic or metabolic vestibulopathies
• Brain tumor encephalopathies
• Psychogenic etiologies
• Subdural hematoma • Compressive myelopathy

Goals for Acute TIA Treatment
In the trauma emergency center
• Initial neuro assessment, history, exam and

cardiac monitoring
• Consider other possible causes of neuro

symptoms
• Urgent brain imaging (with CT or MRI) to

rule out ischemic or hemorrhagic stroke

Goals for Acute TIA Treatment
In the trauma emergency center
• Neurovascular imaging (MRA, CTA, or TCD)

to assess arteries
• Cardiovascular evaluation to identify cardio

source of emboli
• Lab tests to rule out metabolic or

hematologic causes of neuro symptoms

What Is a MRA?
MRA (magnetic resonance angiogram) is a

type of magnetic resonance imaging (MRI)
scan.

What Is a MRA?
• An MRA can be done with the same machine as a

MRI and uses a magnetic field and pulses of radio
wave energy to provide pictures of blood vessels
inside the body.
• An MRA of the head is done to look at the blood

vessels leading to the brain to check for a bulge
(aneurysm), a clot, or a narrowing (stenosis)
because of plaque.
• The patient will lie on a table and the table moves

into the MRI machine and the test is usually
completed in 30 60 minutes.
Germain Orphanet Journal of Rare Diseases 2007 2:32 doi:10.1186/1750-1172-2- Angio-MRI (coronal section
https://commons.wikimedia.org/wiki/File:Angio_MR.jpg, CC BY 2.0, cropped
What Is a CTA?
CTA is a computed tomography angiogram

(CT angiogram).

What Is a CTA?
• This test uses X-rays to provide detailed

pictures of the heart and the blood vessels
that go to the heart, lung, brain, kidneys,
head, neck, legs, and arms.
• The test is non-invasive and dye (contrast

media) is given IV to make the vessels easier
to scan.
• Patients taking metformin need a

before and after receiving contrast.
• Renal patients also need careful monitoring.
Mikael Häggström, M.D., CC0 1.0

What Is a TCD?
A transcranial Doppler is a non-invasive and

painless neurovascular ultrasound that uses
high-frequency sound waves.

What Is a TCD?
• A TCD measures the rate and direction of

blood flow inside the arteries of the circle of
Willis.
•
the temples, base of the skull at the back of
the neck, or on closed eyelids.
• TCD can be used in the diagnosis of TIA, CVA,

or subarachnoid hemorrhage (SAH).
Runeaaslid, Transcranial Doppler Insonation of the Cerebral Circulation, https://commons.wikimedia.org/wiki/File:Transcranial_doppler.jpg,

Goals for Stroke Prevention
Address underlying cause of TIA
Medication options:
if identified:
• Monitor and control
• Carotid occlusion, artery stenosis,
blood pressure with
cardiogenic embolism, intracranial
antihypertensives as
larger artery atherosclerosis
appropriate
• Statins
Lifestyle modification:
• Antiplatelets
• Healthy diet, increased
activity/exercise, smoking cessation

In a Nutshell
 Transient ischemic attacks are caused by

interruption of blood flow to a local portion
of the brain.
 TIAs are warning signs to seek medical

evaluation as the patient is at an increased
risk for having a stroke.
 Medical evaluation will help to identify the

underlying cause of the TIA and plan the
most effective treatment options to minimize
the risk of developing a stroke.

This document is a property of: MAYA LAKO
Note: This document is copyright protected. It may not be copied, reproduced, used, or
distributed in any way without the written authorization of Lecturio GmbH.


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Transient Ischemic Attacks

With Rhonda Lawes

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

Relatively brief ischemia can cause permanent brain injury.

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

TIAs are a warning sign and patients should

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

Usually last a short period of time (< 24 hours)

Neurologic symptoms present

Focal brain, spinal cord, or retinal ischemia

Symptoms vary based on location of ischemia

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

Infarcted CNS tissue

Symptoms vary based on size and location of infarct

Neurologic deficits remain longer than TIA

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

TIA Ischemic stroke

Neurologic symptoms present Neurologic symptoms present

No infarction of tissue Infarcted CNS tissue

Symptoms vary based on location Symptoms vary based on size

Focal brain, spinal cord, or retinal

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

Less common but possible causes:

• Hypoglycemia • Cerebral amyloid • Nerve root compression

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

In the trauma emergency center

• Initial neuro assessment, history, exam and

• Consider other possible causes of neuro

• Urgent brain imaging (with CT or MRI) to

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

In the trauma emergency center

• Neurovascular imaging (MRA, CTA, or TCD)

• Cardiovascular evaluation to identify cardio

• Lab tests to rule out metabolic or

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

MRA (magnetic resonance angiogram) is a

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

• An MRA can be done with the same machine as a

• An MRA of the head is done to look at the blood

• The patient will lie on a table and the table moves

CTA is a computed tomography angiogram

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

• This test uses X-rays to provide detailed

• The test is non-invasive and dye (contrast

• Patients taking metformin need a

• Renal patients also need careful monitoring.

Mikael Häggström, M.D., CC0 1.0

A transcranial Doppler is a non-invasive and

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

• A TCD measures the rate and direction of

• TCD can be used in the diagnosis of TIA, CVA,

Runeaaslid, Transcranial Doppler Insonation of the Cerebral Circulation, https://commons.wikimedia.org/wiki/File:Transcranial_doppler.jpg,

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

 Transient ischemic attacks are caused by

 TIAs are warning signs to seek medical

 Medical evaluation will help to identify the

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

MAYA LAKO, thoughgol.d.en.24.8.4@gmail.com

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