What Is a Transient Ischemic Attack (TIA)? Symptoms, Causes, and Treatment of Ministrokes

When you experience stroke symptoms, it’s impossible to know if they will resolve on their own, get worse, or become permanent. A transient ischemic attack (TIA) can be thought of as a temporary stroke that doesn’t lead to any permanent brain damage. But when the symptoms first start, there’s no way for you to tell if they are from a TIA or a stroke. And what’s more, 1 in 3 people who have a TIA will go on to develop a stroke. 

In this article we will explain what causes a TIA, what to do if you or a loved one develops symptoms, and how you might prevent a stroke if you’ve had a TIA.

What causes a transient ischemic attack?

A TIA is caused by a sudden decrease in blood flow to a part of the brain. This happens when there’s a blockage in one of the arteries in the brain. The blockage can be caused by a:

• Buildup of plaque and cholesterol that narrows the artery

• Blood clot that develops at the site of the plaque

• Blood clot that travels from another part of the body, like the heart or carotid artery in the neck

• Spasm in the artery — although this is much more rare

Most of the time, the cause of a TIA can be easily identified. But in rare cases, the cause of the TIA remains unknown.

What are the symptoms of a TIA?

The symptoms of a TIA are identical to those of a stroke. The difference is they only last a few minutes to an hour. But when symptoms begin, it’s impossible to know if they will reverse themselves, or if they are signs of a bigger stroke. Symptoms depend on which part of the brain is affected.

Typical stroke symptoms may include sudden:

• Numbness or weakness on one side of the body

• Difficulty speaking — including trouble making sense, finding words, and pronouncing them

• Poor balance or coordination

• Dizziness, vertigo, or trouble walking

• Disorientation, confusion, or memory loss

If you or someone you know develops these symptoms, it’s best to get emergency medical attention. 

How is a TIA different from a stroke?

The main difference between a TIA and a stroke is how long the symptoms last. A TIA doesn’t last long — only a few minutes to an hour. And because the lack of blood flow to the brain is brief, there’s no permanent damage to the brain. This also means that TIAs, unlike strokes, don’t cause visible changes on imaging tests like brain MRIs or CT scans. 

But just because TIAs are smaller than strokes doesn’t mean they shouldn’t be taken just as seriously. You may be tempted to dismiss the symptoms when they go away quickly. Or you may assume everything is fine when the CT or MRI results are normal. But a TIA can be a warning sign of a future stroke. On the upside, it can give you a chance to make changes that could prevent a future TIA or stroke. 

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How is a TIA diagnosed?

There’s no single test that can diagnose a TIA. Because a TIA is caused by a temporary lack of blood flow to the brain, the symptoms may get better before you reach a medical care provider. And a CT scan or MRI of the brain may be normal. 

So how do you know if you had a TIA? A medical professional will make a diagnosis based on your history and physical exam. They will ask a lot of questions about how quickly symptoms started and how long they lasted. They will do a neurologic exam to look for any problems with weakness, changes in sensation, or lack of coordination. 

If your medical team suspects a TIA, they will order tests to try to figure out why it happened. Common tests after a TIA include: 

• Electrocardiogram (ECG or EKG): This maps electrical conduction in the heart. An EKG can help diagnose abnormal heart rhythms that may lead to TIA or stroke, like atrial fibrillation. 

• Carotid ultrasound: This test looks for signs of blocked blood flow through the arteries in the neck. 

• Echocardiogram (TTE): An echocardiogram is an ultrasound of the heart. It can look for blood clots within the heart that can travel to the brain and cause TIA or stroke.  

• Blood tests: These help to look for bleeding or clotting disorders. Blood tests can also find high cholesterol or elevated blood sugars that increase the risk of TIA or stroke. 

What is the treatment for a TIA?

Treatment for TIA depends on the suspected cause of the impaired blood flow to the brain. You may be asked to start medications to help reduce the risk of another TIA or stroke, such as:

• Anti-platelet medication: Taking a daily anti-platelet medication, such as aspirin, can help prevent stroke. 

• Anticoagulants: Blood thinners like warfarin (Coumadin) or rivaroxaban (Xarelto) are prescribed if you have a blood clot that could lead to a stroke. 

• Statins: Statins are cholesterol-lowering medications that help prevent the narrowing of blood vessels to the brain. They also help stabilize the plaque that builds up in arteries so that it won’t break off, block blood flow, and cause a stroke.  

• Blood pressure medication: High blood pressure (hypertension) is another risk factor for stroke. You can manage hypertension with blood pressure medication.

Who is at risk for TIA?

It probably comes as no surprise that the risk factors for a TIA are similar to those of a stroke. You can’t change some of these risk factors because they are a part of who you are. But others are conditions that you can improve or modify to reduce the risk of a stroke.

Things that can’t be changed include: 

• Genetics: Some genetic conditions that affect the blood (such as sickle cell anemia and clotting disorders) and blood vessels (such as Moyamoya disease) may increase stroke risks.

• Family history: There’s a 50% higher risk of stroke for those with a first-degree relative (parents or siblings) who has had a stroke. 

• Older age: The risk of a stroke increases with age. The risk of stroke doubles every 10 years after age 55.

• Female sex: Strokes are more common in women than men. This is probably related to blood pressure and blood sugar changes during pregnancy, along with the use of oral contraceptives.

• Race and ethnicity: Blacks, Hispanics, and Native Americans are at higher risk of strokes and TIAs than non-Hispanic whites and Asians.

How to prevent transient ischemic attacks

There are a lot of risk factors that you do have control over. Things you can change or manage to help prevent TIA include: 

• Smoking: Nicotine damages artery walls. This predisposes them to plaque formations that narrow blood vessels. Nicotine is present in e-cigarettes (vaping), nicotine gum, and patches. Cigarettes also contain tar and other harmful chemicals.

• Diabetes: High blood sugar damages arteries over time. This is one of the reasons it’s important to keep blood sugar in a healthy range through diet, exercise, and taking medications if needed.

• High blood pressure: Elevated pressure within an artery stretches out the walls of the blood vessel. This can cause scarring and narrowing. Blood pressure medications may reduce the risk of this kind of damage.

• Heart disease: Heart rhythm problems or a weakened heart muscle can predispose you to blood clot formation. Clots from the heart can travel through arteries and get stuck in the brain. Medications may help to control the heart rhythm, improve its pump strength, or prevent the formation of blood clots.

• Obesity: Increased body fat creates resistance that can raise pressure in blood vessels. This causes damage similar to the way high blood pressure does. And obesity also puts you at risk for diabetes, heart disease, and high cholesterol.

• Lack of exercise: A sedentary lifestyle contributes to poor heart and artery health. But even just 30 minutes of walking every day can help reduce your risk of stroke.

• Alcohol intake: Heavy drinking increases the risk of high blood pressure. This can increase the risk of stroke, especially in the days immediately after a binge drinking event. 

Addressing some of the above risk factors may seem daunting at first. But you don’t need to change all of them at once. Take the first step by starting with one. Small changes from day to day can have a big impact over time. 

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Written by:

Valerie Anne Jones, MD

Val Jones, MD, is a physician who is certified by the American Board of Physical Medicine and Rehabilitation (ABPMR).

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

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