Transient Ischemic Attack (TIA): 'Mini-Stroke' Recognition and Urgent Action

A Transient Ischemic Attack (TIA) is a temporary focal neurological deficit caused by transient cerebral ischemia without acute infarction (no permanent damage on MRI-DWI). It is a medical emergency—a warning stroke.

Key Features

• Duration: Typically <1 hour (often 5–15 min); by definition <24 hours.
• Symptoms (FAST +): Face drooping, Arm weakness, Speech difficulty, Time to call 911. Also: sudden vision loss (amaurosis fugax), diplopia, vertigo, ataxia, sensory loss.
• Resolution: Complete, spontaneous.

Immediate Action

• Call 911 / emergency services immediately. Do not drive. Do not wait to see if it recurs.
• Time of onset critical for treatment decisions.

Risk of Subsequent Stroke

• 10–20% within 90 days (highest first 48h – 5–10%).
• ABCD² score stratifies risk (Age, BP, Clinical features, Duration, Diabetes).

Urgent Workup (Within 24 Hours)

• Brain MRI with DWI (gold standard – detects infarct in 30–50% of "TIAs").
• Vascular imaging: CTA/MRA head/neck (carotid stenosis, intracranial atherosclerosis).
• Cardiac: ECG, telemetry, echocardiogram (TTE/TEE) for AF, thrombus, PFO.
• Labs: CBC, glucose, lipids, HbA1c, renal, coagulation.

Secondary Prevention (Start Immediately)

• Antiplatelet: Aspirin 160–325 mg loading, then 81 mg daily (or clopidogrel, aspirin/dipyridamole). Dual antiplatelet (aspirin + clopidogrel × 21–90 days) for minor stroke/high-risk TIA (CHANCE, POINT trials).
• Anticoagulation: If cardioembolic (AF, mechanical valve) – DOAC preferred.
• Statin: High-intensity (atorvastatin 40–80, rosuvastatin 20–40) regardless of LDL.
• BP control: Target <130/80.
• Diabetes management: SGLT2i/GLP-1 RA if indicated.
• Carotid revascularization: If symptomatic ≥50% stenosis (CEA or CAS).
• Lifestyle: Smoking cessation, Mediterranean diet, exercise, weight control.

TIA is a stroke that didn't finish. Treat it like a stroke emergency.