Introduction:

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 - 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 have 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 and balance
• Loss of consciousness
• Temporary memory problems
• Headache
• Confusion

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)
• A rapid, irregular heartbeat (atrial fibrillation)
• Narrowing of the main artery in your neck (carotid artery) together with low blood pressure
• 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
• Sleep apnea
• Hypothyroidism

What to Expect at Your Provider's Office:

If you have symptoms of TIA, see your health care provider. You should assume all stroke-like symptoms are an emergency and should not wait for symptoms to go away. Your health care 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 health care 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.
• Exercise regularly, eat a healthy diet, and maintain a healthy weight.
• Use dietary supplements when appropriate (see "Nutrition and Supplements" section).
• Don't drink alcohol excessively.
• Work with your health care provider to control high blood pressure, high cholesterol, or diabetes.
• Work with your health care 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.
• Sleep for 6 - 9 hours each night.

Treatment Plan

Treatment will depend on your signs and symptoms, exams, and tests. Your health care 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 health care 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. Many drugs and dietary supplements interact with these types of medications. Talk to your pharmacist.

Surgical and Other Procedures

If your carotid artery is narrowed, your health care 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 health care 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).

Tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present), or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
• Magnesium citrate, 200 - 400 mg daily, for heart health.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoon of oil 2 - 3 times daily, to help decrease inflammation, and for heart health. Cold-water fish, such as salmon or halibut, are good sources. If you are taking blood-thinning medications, talk to your doctor before taking omega-3 fatty acids. Overly thin blood can increase the risk of TIAs.
• Vitamin C, 500 - 1,000 mg 1 - 3 times daily, as an antioxidant, and for blood vessel support.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and heart protective activity.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and heart support.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects and heart support.
• Melatonin, 2 - 5 mg before bed, when needed for sleep, and for antioxidant support.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and heart protective effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Grape seed (Vitis vinifera) standardized extract, 100 - 200 mg 3 times daily, for antioxidant effects, and heart and blood vessel protection.
• Policosanol (from sugar cane wax), 10 - 40 mg daily, for cholesterol and blood vessel protection.
• Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg 3 times daily, for antioxidant and blood vessel support. If you are taking blood-thinning medications, talk to your doctor before taking Ginkgo.
• Garlic (Allium sativum), standardized extract, 400 mg 2 - 3 times daily, for heart and antioxidant protection.

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 and any current symptoms.

Acupuncture

Acupuncture plays a role in the circulation of blood in your head and in reducing adverse effects when blood flow returns.

Chiropractic

Chiropractors do not treat TIAs, and many medical experts consider high velocity manipulation of the upper spine to be inappropriate for individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke.

Prognosis/Possible Complications:

The shorter the amount of time between TIAs, the more likely you are to 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 length 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 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 health care provider's advice on getting checkups after a TIA to prevent stroke and heart attack. About one-third of people who have a TIA will have an acute stroke at some time in the future. Half of these strokes occur within a year, and 20% occur within 5 months.

Alternative Names:

Stroke - transient; TIAs