Transient Ischemic Attack (TIA): Etiology, Risk Factors, and Emergency Response

Mechanisms

• Embolic: Cardiac (AFib, valve, thrombus) or aortic arch atheroma → cerebral artery occlusion.
• Atherothrombotic: Large-vessel stenosis (carotid, vertebral, intracranial) → hemodynamic failure or artery-to-artery embolism.
• Small Vessel (Lacunar): Lipohyalinosis of penetrating arterioles (hypertension, diabetes).
• Vasospasm / Vasculitis / Dissection.

Risk Factors (ABCD² Score Components)

• Age ≥60
• BP ≥140/90 at presentation
• Clinical: unilateral weakness (2), speech only (1), other (0)
• Duration: ≥60 min (2), 10–59 min (1), <10 min (0)
• Diabetes

Warning Symptoms (BE-FAST)

• Balance loss
• Eyes (vision change)
• Face droop
• Arm weakness
• Speech difficulty
• Time to call 911

Urgency

10–20% stroke risk within 90 days (half within 48 hours). TIA = stroke that resolved. Workup identical to stroke: MRI/DWI, vascular imaging, cardiac monitoring, labs. Start antiplatelet/anticoagulant per etiology.