Transient Ischemic Attack Explained: Warning Signs and Risks

The term “mini-stroke” is a dangerous and misleading phrase. It suggests that a Transient Ischemic Attack (TIA) is a minor, almost harmless event—a warning that is inconvenient but not truly urgent. This perception is wrong. While the symptoms of a TIA are temporary, the underlying cause is not, and the event itself is a dire warning that a major, debilitating stroke may be imminent. A TIA is a medical emergency. It is a rare second chance to take action and prevent a catastrophic event. This article will explain why you should never ignore the symptoms of a “mini-stroke.”

A Transient Ischemic Attack (TIA) is a temporary episode of neurological dysfunction caused by a brief interruption of blood flow to part of the brain, spinal cord, or retina. It is, by definition, a stroke that doesn’t cause permanent damage. The key difference between a TIA and a full-blown stroke is that the symptoms of a TIA resolve completely on their own, usually within an hour, and there is no evidence of permanent damage on brain imaging. ^[1]

The underlying cause of a TIA is typically a small blood clot or a piece of plaque that breaks off from a larger deposit (atherosclerosis) in an artery and temporarily blocks a blood vessel in the brain. This clot briefly cuts off the oxygen supply to a part of the brain. The symptoms appear suddenly and then resolve completely when the clot breaks up or dissolves on its own.

The fact that the symptoms of a TIA are temporary is precisely why it is so dangerous. It gives a person a false sense of security, leading them to believe that because the symptoms have disappeared, the problem is gone. This is a life-threatening misconception.

• A Warning of a Major Stroke: A TIA is a powerful predictor of a future stroke. It is estimated that roughly 1 in 3 people who have a TIA will eventually have a stroke, with half of those strokes occurring within a year. ^[2] The risk is highest in the first 48 hours following a TIA. ^[3] A TIA is a ticking clock, and the time to act is now.
• The Underlying Cause Is Still There: The clot that caused the TIA may have dissolved, but the underlying conditions that caused it in the first place—such as a large plaque buildup in a carotid artery, uncontrolled high blood pressure, or a heart rhythm disorder like atrial fibrillation—are still present and ready to cause another, and this time permanent, blockage.
• Identical Symptoms to a Stroke: The symptoms of a TIA are identical to the symptoms of a stroke, and there is no way for a person to tell the difference on their own. The only way to know is to be evaluated by a medical professional. The American Stroke Association uses the acronym F.A.S.T. to help people remember the signs of a stroke. The same acronym applies to a TIA:^[4]
  • Face drooping: One side of the face droops or is numb.
  • Arm weakness: One arm is weak or numb.
  • Speech difficulty: Speech is slurred, or the person is unable to speak.
  • Time to call emergency services: If you or someone you know has any of these symptoms, call 911 immediately.

Other common symptoms can include sudden vision loss in one eye, dizziness, loss of balance, or difficulty walking.

If you are experiencing swollen ankles from your blood pressure medication, it is crucial to communicate with your doctor. Do not stop taking your medication on your own. There are also several simple, actionable steps you can take to manage the swelling.

1. Elevate Your Legs: When sitting, elevate your feet and legs on a stool or pillows to help gravity assist in the fluid’s return to the heart.¹²
2. Wear Compression Stockings: Mild compression stockings can help to reduce fluid buildup in the lower legs and ankles by applying gentle pressure to the area.¹³
3. Stay Active: Regular, light exercise like walking can help improve circulation and reduce swelling.
4. Discuss Your Symptoms: Be open with your doctor about your symptoms. They can help determine if the swelling is indeed a side effect of the medication or if it’s a sign of a different issue that needs to be addressed.

The most important takeaway from this article is that if you or someone you know experiences the symptoms of a TIA, even if they disappear, you must call 911 immediately.

Calling emergency services is crucial because the window of opportunity for effective stroke treatment is very small. While it may not be a stroke, the paramedics can begin the diagnostic workup on the way to the hospital, saving precious time. In the hospital, a doctor will immediately conduct tests to determine the cause of the TIA and assess your risk for a future stroke. These tests may include:

• Brain Imaging: An MRI or CT scan to look for signs of permanent damage and rule out a stroke.
• Carotid Ultrasound: An ultrasound of the arteries in the neck to check for plaque buildup that could be the source of the clots.
• Heart Monitoring: An EKG or a Holter monitor to check for heart rhythm problems, especially atrial fibrillation, which is a major cause of blood clots. ^[5]
• Blood Tests: To check for underlying conditions like high cholesterol, diabetes, and other risk factors.

The goal of a TIA workup is to identify the underlying cause and implement a plan to prevent a future, more serious stroke. A TIA is a rare opportunity to be proactive and change the course of your health. The treatment plan will depend on the findings of the diagnostic workup.

• Control Risk Factors: This is the most important step. A doctor will work to aggressively manage your blood pressure, control your cholesterol and blood sugar, and strongly recommend that you quit smoking. These are the key levers for preventing a future stroke.

• Medication: Depending on the cause of the TIA, a doctor will likely prescribe a medication to prevent future clots. This could be an antiplatelet agent (e.g., aspirin or clopidogrel) if the TIA was caused by plaque buildup, or an anticoagulant (e.g., warfarin or a newer drug like apixaban) if the cause was a heart rhythm disorder. ^[6]

• Surgical Intervention: For patients with severe blockage in the carotid artery, a surgical procedure called a carotid endarterectomy may be necessary to remove the plaque and restore blood flow to the brain, significantly reducing the risk of a stroke. ^[7]