TIA Assessment

Rapid Assessment of Transient Ischemic Attacks

What is a Transient Ischemic Attack?

Transient ischemic attacks are often called mini-strokes. This is because they share similar characteristics to strokes in that they occur when the blood supply to a part of the brain is interrupted.

What distinguishes transient ischemic attacks (TIAs) from strokes, however, is their duration and impact. They typically only last about 10 minutes, though some can last as long as 24 hours. And unlike full-blown strokes, they don't cause any irreversible neurological damage.

What are the symptoms of Transient Ischemic Attacks?

The symptoms of TIAs are the same as the symptoms of strokes. They can include numbness or weakness in the arm, leg or face - especially on one side of the body; dizziness or loss of balance and coordination; trouble with vision in one or both eyes; and difficulty speaking or understanding speech; a headache that comes on suddenly; and extreme drowsiness.

What are the risk factors for TIAs?

Like stroke, risk factors for TIAs include smoking, high blood pressure, diabetes, carotid artery disease, excessive use of alcohol, obesity, sedentary lifestyle and heart disease.

How prevalent are TIAs?

Approximately 50,000 people in the United States have transient ischemic attacks every year. They most often strike people over the age of 60, and whites tend to have a higher rate of TIAs than blacks.

Are people who have Transient Ischemic Attacks more susceptible to stroke than those that don't?

Yes, research shows that approximately one third of those who have TIAs eventually go on to have full-blown strokes.

How are they diagnosed?

Doctors examine the arteries leading to the brain with ultrasound, magnetic resonance imaging (MRIs), magnetic resonance angiography (MRAs) and CT scans. They also run electrocardiograms to detect arrhythmias or abnormal heartbeats and a variety of other laboratory tests.

A complete blood cell count (including the number of platelets), and measurements of glucose levels, creatinine levels and electrolytes are some of the tests doctors use to diagnose TIAs. The blood is tested to rule out hematologic problems such as anemia, leukocytosis and polycythemia.

Doctors should also conduct a complete physical examination, monitoring such vital signs as body temperature, blood pressure and breathing patterns.

Why is it so important to diagnose TIAs quickly and accurately?

Doctors must be vigilant with TIAs since their symptoms mimic those of strokes. Timing is very important because early treatment produces the best results.

Because most TIAs only last a few minutes, doctors should talk to as many people as possible that witness the attack, including family members and emergency medical services (EMS) personnel. It is important for doctors to learn how the symptoms of the attack began and developed because that information can help them determine whether a true TIA has occurred as opposed to a seizure, migraine or hypoglycemic incident.

It is also important for doctors to find out about a patient's medical history because it helps doctors figure out the severity and possible cause of the attack. Whether or not a patient has suffered from a recent head or neck trauma, has used alcohol, drugs or oral contraceptives, has a history of migraine or a family history of stroke makes a huge difference in determining the most effective approach to care.

What is the University of Maryland Medical Center doing in the area of rapid assessment of TIAs?

A component of the Maryland Brain Attack Center is the Rapid Assessment of Transient Ischemic Attack Etiologies (RATE), which was developed to evaluate patients with TIA and to identify risk factors and potential stroke causes and then quickly treat them to prevent an actual stroke. This rapid evaluation is performed within 24 hours and patients are provided secondary stroke prevention and follow-up.

More rapid work-up and intervention result in less disability and more rapid advancement to rehabilitation and post-acute care services, which are provided through the University Rehabilitation Network. All levels of post-acute care are provided through the Network, ranging from home health services to subacute and acute rehabilitation as well as long term care.

Why should I come to the University of Maryland Medical Center if I think I'm having a transient ischemic attack?

The Medical Center has a highly specialized team of neurologists, neurosurgeons, nurses and other health professionals who provide the rapid evaluation needed when the brain comes under attack. The Brain Attack Team (BAT) works out of the Maryland Brain Attack Center, using the most advanced diagnostic technologies and treatment approaches available.

The Brain Attack Team offers stroke care 24 hours a day, seven days a week. No other medical center in the state offers this kind or level of service. BAT is trained to evaluate patients with TIA quickly, and to identify risk factors and potential stroke causes in order to prevent an actual stroke from occurring.

This rapid evaluation is performed within 24 hours of the onset of a TIA, and patients are provided secondary stroke prevention and follow-up care.

For more information about the University of Maryland Departments of Neurology and Neurosurgery, or to make an appointment, call the University Physicians Consultation and Referral Service at 1-800-492-5538 (patients) or 1-800-373-4111 (physicians).