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Table of Contents > Conditions > Transient Ischemic Attacks
Transient Ischemic Attacks
Also Listed As:  Stroke, Transient; TIAs
 
Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Prevention
Treatment Plan
Drug Therapies
Surgical and Other Procedures
Complementary and Alternative Therapies
Prognosis/Possible Complications
Following Up
Supporting Research

Transient ischemic attacks (TIAs), sometimes called "mini-strokes," are caused by temporary reduction of blood flow to the brain. Generally, TIAs occur when platelets in the blood clump together in your arteries, blocking blood flow. Symptoms usually last only 10 to 15 minutes and clear up within 24 hours. TIAs sometimes happen before strokes, and they are considered a warning sign of stroke.


Signs and Symptoms

You may experience the following signs and symptoms during a TIA:

  • Blurred vision in both eyes, brief blindness, or double vision
  • Difficulty speaking
  • 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; clumsiness
  • Loss of consciousness
  • Temporary memory problems
  • Headache

What Causes It?

TIAs are commonly caused by emboli—materials that block your blood vessels. These may include clumps of platelets and fibrin (a component of blood involved in clotting), plaque (often called atherosclerosis) that has collected in your arteries, or blood clots. Some other conditions that can cause TIAs include a weakened, bulging heart wall (ventricular aneurysm); rapid, irregular heartbeat (atrial fibrillation); narrowing of the main artery in your neck (carotid artery) together with low blood pressure; and blood clotting problems.


Who's Most At Risk?

These characteristics increase your risk for TIA:

  • Over 65 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
  • Hypercoagulability—an inherited condition that increases the likelihood of developing blood clots, including during pregnancy

What to Expect at Your Provider's Office

If you have symptoms of TIA, see your healthcare provider. Your provider will ask about your symptoms, examine you, and may perform 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 provider 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 another event and what the cause may have been.


Treatment Options
Prevention

You can take the following steps to help prevent TIA:

  • Don't smoke.
  • Get regular exercise, eat a healthy diet, and maintain a healthy weight.
  • Don't drink alcohol excessively.
  • Work with your 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.
  • Stay on hormone replacement therapy if you are already taking it.

Treatment Plan

Treatment will depend on your signs and symptoms, exam, 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 (drugs that prevent blood from clotting). These include aspirin, ticlopidine, clopidogrel, dipyridamole, and warfarin.


Surgical and Other Procedures

If your carotid 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 (inserting a balloon, a tube-like structure called a stent, or another device into your artery to open it). Depending on your condition, your provider may recommend an extracranial-intracranial bypass, surgery that connects a blood vessel outside your skull with a blood vessel inside to improve blood flow.


Complementary and Alternative Therapies

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 occurs in the body with age and in response to exposure to certain agents such as cigarette smoke and fatty foods). Acupuncture plays a role in the circulation of blood in your head and in reducing adverse effects when blood flow returns.


Nutrition

An important, long-term study called the Framingham Study showed that among men aged 45 to 65 years with no known history of vascular disease, those who ate more fruits and vegetables had a lower risk of stroke and TIAs. A study of 14,916 men aged 40 to 84 years examined whether homocysteine levels would be a good predictor of stroke risk. The study showed homocysteine levels were slightly, but not significantly, higher in men who later had strokes. Homocysteine levels were a better predictor of stroke in men who had normal blood pressure or were 60 years old or younger. Folic acid (vitamin B9), vitamin B6, vitamin B12, and betaine affect your body's use of homocysteine. Taking these supplements may help control homocysteine levels.

A review of the role of magnesium in vascular disease shows a link between the dietary intake of magnesium, the amount of magnesium in the heart and blood vessels, and the risk for developing TIAs and other blood vessel problems. This suggests that taking magnesium through dietary sources (such as green leafy vegetables, whole grains, nuts and seeds, tofu, oatmeal, bananas, potatoes, and molasses) may be useful; not enough information is available to determine if magnesium supplements are worthwhile.

A study of 10 patients who suffered a stroke related to reduced blood flow showed that the supplement acetyl-L-carnitine improved blood flow around, but not directly in, the affected site in the brain. In an animal study, treatment with acetyl-L-carnitine before reducing blood flow protected nerve cells. This supplement may help prevent TIAs for high-risk patients and/or may prevent further brain damage for those who have already suffered a TIA or an ischemic stroke.

Vitamin E helps prevent platelets from sticking together, which improves blood flow. In a 2-year study, 100 patients with a history of cerebrovascular events were randomly assigned to take either aspirin or a combination of aspirin and vitamin E. Those taking the combination had fewer platelets collecting in blood vessels and improved blood flow. Several animal studies have also shown that vitamin E protects against the effects of reduced blood flow.

Vitamin B3 is under investigation as a possible treatment for TIAs in humans. In animal studies, rats were treated with vitamin B3 following a TIA. Results showed the treatment protected the nerve cells and reduced damage from the TIA. More research is necessary to determine if the same is true for people.


Herbs

Ginkgo (Ginkgo biloba) appears to increase circulation in the head, helps the brain tissue tolerate lack of oxygen, controls brain swelling, improves brain function, protects nerve cells, and lessens the likelihood of platelets collecting in blood vessels. In animal studies, treatment with ginkgo before intentionally causing a TIA helped preserve the brain membrane.

Oren-gedoku-to (TJ15), a Chinese herbal preparation, reduced nerve cell damage in mice with reduced blood flow to the brain. Specialists trained in Chinese medicine and licensed to prescribe Chinese remedies would decide whether this herb or others might be useful for you if you have a history of TIA or stroke.


Homeopathy

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 andany current symptoms.


Acupuncture

In an animal study of reduced blood flow to an area of the head, scalp acupuncture improved neurologic symptoms and blood flow, helped repair damage, and reduced swelling, inflammation, and tissue death. In a study of patients with cerebrovascular disease, electrical stimulation of the needles during acupuncture (called electro-acupuncture) caused improvement in blood flow to the brain compared to acupuncture alone. Animal studies have confirmed the benefits of electro-acupuncture in protecting overall function in the brain when blood flow is reduced and in improving recovery when blood flow returns.

Pointed massage on acupuncture points (called acupressure) improved blood flow in the head in 120 patients with brain disorders due to poor circulation and a history of TIAs in the vessels supplying blood to the back of the head.


Chiropractic

Chiropractors do not treat TIAs, and high velocity manipulation of the upper spine is considered inappropriate in individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke. It should also be noted that chiropractic spinal manipulation of the neck is associated with an exceedingly small risk of stroke (0.5 strokes reported per 2 million spinal manipulations).


Prognosis/Possible Complications

The shorter the amount of time between TIAs, the more likely it is that you will have a stroke; this seems to be the most important predictor of stroke risk. Narrowing of the carotid arteries also indicates likelihood of suffering a stroke. The location or duration of symptoms do not appear to be indications of stroke risk.

TIAs are a warning sign of stroke. But more patients 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 stem 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 provider's advice on getting checkups after a TIA to prevent stroke and heart attack. In people who have strokes after TIAs, half the strokes occur within a year, and 20% occur within 5 months.


Supporting Research

Abou-Zamzam AM, et al. Extrathoracic atrial grafts performed for carotid artery occlusive disease not amenable to endarterectomy. Arch Surg. 1999;134:952-957.

Albers GW, Hart RG, Helmi LL, Newell DW, Sacco, RL. AHA Scientific Statement Supplement to the guidelines for the management of transient ischemic attacks: A statement from the ad hoc committee on guidelines for the management of transient ischemic attacks, stroke council, American Heart Association. Stroke. 1999;30:2502-2511.

Altura BM, Altura BT. New perspectives on the role of magnesium in the pathophysiology of the cardiovascular system. Magnesium. 1985;4(5-6):226-244.

Altura BM, Gebrewold A. Alpha-tocopherol attenuates alcohol-induced cerebral vascular damage in rats: possible role of oxidants in alcohol brain pathology and stroke. Neurosci Lett. 1996;220(3):207-210.

Blumenthal M, Busse WR, Goldberg A, et al., eds.The Complete German Commission E

Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass:Integrative Medicine Communications; 1998: 136-138, 159-160, 172, 197.

Caplan LR, et al. Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? N Engl J Med. 1997;337:1309-1310.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine, 20th ed. Philadelphia, Pa: W.B. Saunders, 1996.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999.

Dziak LA, Golik VA. [The efficacy of treating cerebral ischemia due to changes in the major cerebral arteries by using the preparation Tanakan (EGB 761).] Lik Sprava. 1998; August(6):125-127.

Gillman MW, Cupples LA, Gagnon D, et al. Protective effect of fruits and vegetables on development of stroke in men. JAMA. 1995;273(14):1113-1117.

Goroll AH, ed. Primary Care Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1995.

Gusarova SA, Kuznetsov OF, Gorbunov FE, Maslovskaia SG. [The use of point massage in patients with circulatory encephalopathy.] Vopr Kurortol Fizioter Lech Fiz Kult. 1997;(6):11-13.

Hara H, Kato H, Kogure K. Protective effect of alpha-tocopherol on ischemic neuronal damage in the gerbil hippocampus. Brain Res. 1990;510(2):335-338.

Henneman PL, Lewis RJ. Is admission medically justified for all patients with acute stroke or transient ischemic attacks? Ann Emerg Med. 1995;25(4):458-63.

Johnson ES, et al. A metaregression analysis of the dose-response effect of aspirin on stroke. Arch Intern Med. 1999;158:1248-1253.

Kondo Y, Kondo F, Asanuma M, Tanaka K, Ogawa N. Protective effect of oren-gedoku-to against induction of neuronal death by transient cerebral ischemia in the C57BL/6 mouse. Neurochem Res. 2000;25(2):205-209.

Kwiatkowski TG, et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. N Engl J Med. 1999;340:1781-1787.

Lei XQ, Wang J, Wang YS. [Effects of scalp acupuncture on focal cerebral ischemia in rats.] Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1997;17(9):544-546.

Miller AL, Kelly GS. Homocysteine metabolism: nutritional modulation and impact on health and disease. Altern Med Rev. 1997;2(4):234-254.

National Stroke Association. 1998 consensus statement: prevention of a first stroke. JAMA. 1999;281:1112-1120.

Pierre S, Jamme I, Droy-Lefaix MT, Nouvelot A, Maixent JM. Ginkgo biloba extract (EGb 761) protects Na,K-ATPase activity during cerebral ischemia in mice. Neuroreport. 1999;10(1):47-51.

Postiglione A, Cicerano U, Soricelli A, et al. Cerebral blood flow in patients with chronic cerebrovascular disease: effect of acetyl-L-carnitine. Int J Clin Pharm Res. 1990;10(1-2):129-132.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, MO: Mosby-Year Book;1998.

Rowland LP. Merritt's Textbook of Neurology. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995.

Sacco RL, et al. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999;281:53-60.

Sakakibara Y, Mitha AP, Ogilvy CS, Maynard KI. Post-treatment with nicotinamide (vitamin B3) reduces the infarct volume following permanent focal cerebral ischemia in female Sprague-Dawley and Wistar rats. Neurosci Lett. 2000:111-114.

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

Shuaib A, Waqaar T, Wishart T, Kanthan R, Howlett W. Acetyl-L-carnitine attenuates neuronal damage in gerbils with transient forebrain ischemia only when given before the insult. Neurochem Res. 1995;20(9):1021-1025.

Steiner M, Glantz M, Lekos A. Vitamin E plus aspirin compared with aspirin alone in patients with transient ischemic attacks. Am J Clin Nutr. 1995;62(suppl):1381S-1384S.

Terrett AG. Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. Des Moines, IA: NCMIC Group; 2001.

The Multicenter Acute Stroke Trial—Europe Study Group. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Eng J Med. 1998;335(3):145-150.

Tybjaerg-Hansen A, Steffensen R, Meinertz H, Schnohr P, Nordestgaard BG. Association of mutations in the apolipoprotein B gene with hypercholesterolemia and the risk of ischemic heart disease. N Engl J Med. 1998;338(22):1577-1584.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Tarcher/Putnam; 1995.

van der Worp HB, Thomas CE, Kappelle LJ, Hoffman WP, de Wildt DJ, Bar PR. Inhibition of iron-dependent and ischemia-induced brain damage by the alpha-tocopherol analogue MDL 74,722. Exp Neurol. 1999;155(1):103-108.

Verhoef P, Hennekens CH, Malinow MR, Kok FJ, Willett WC, Stampfer MJ. A prospective study of plasma homocysteine and risk of ischemic stroke. Stroke. 1994;25(10):1924-1930.

Wang F, Jia SW. [Effect of acupuncture on regional cerebral blood flow and cerebral functional activity evaluated with single-photon emission computed tomography.] Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1996;16(6):340-343.

Ying S, Cheng J. Effects of electro-acupuncture on EEG during transient global ischemia and reperfusion in gerbils. Chen Tzu Yen Chiu. 1994;19(1):29-32.


Review Date: October 2000
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic College, Maryland Heights, MO; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative Therapeutics, Inc., Natick, MA.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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