Content provided by the Faculty of the Harvard Medical School

Ask the doctor: What to do about TIAs?

Ask the doctor

What to do about TIAs?

Q. For the last few years, I have been experiencing what I think are mini-strokes. The first time it happened, I lost the sight in one eye for about a minute. Sometimes the vision in both eyes gets blurred for a few minutes. A few weeks ago I could not think of the word "battery" while talking with a friend. Otherwise, I am a healthy 77-year-old who exercises, isn't overweight, and doesn't smoke. My doctor hasn't suggested any tests or courses of action. Can you?

A. One of the problems with transient ischemic attacks (TIAs) is that it is sometimes hard to tell what is a TIA and what isn't. The vision problems you mention are more troubling than not being able to remember a particular word — that happens to almost everyone. If you knew the word but couldn't say it, that would be worrisome.

Let's assume that you are having TIAs. The most important thing you can do is get to an emergency room, or call 911, when one is happening. Why? Full strokes can start out just like TIAs, and one in three people who have a TIA goes on to have a full-blown stroke, sometimes in the next day or two. The sooner you get to the hospital, the sooner treatment can get started to break up or remove the blood clot that is blocking an artery feeding your brain. It's also possible that the symptoms you are having will offer clues as to what is going on.

Once the crisis has passed, your doctors should start looking for what caused the TIA. An ultrasound scan can show if one or both of the carotid arteries in your neck are narrowed by cholesterol-filled plaque. Your doctor may also recommend having a CT scan or MRI. Sometimes it is necessary to look directly inside the carotid arteries with an arteriogram in order to get a better look at the plaque and the degree of narrowing.

Another important test is an electrocardiogram. It can detect atrial fibrillation — a fast, irregular rhythm in the heart's upper chambers that can generate small clots that can cause a TIA or stroke. You might also need prolonged heart rhythm monitoring, because atrial fibrillation can come and go. Blood tests can spot, or rule out, problems that cause blood to clot more readily than it should. Recurrent TIAs or stroke may even be due to a small hole in the heart, called patent foramen ovale, which can be detected with an echocardiogram.

Once the source of recurrent TIAs has been found, you and your doctor can decide what to do about it. In March 2006, the American Heart Association/American Stroke Association published new guidelines for preventing future strokes in individuals who have had a stroke or TIA. Strategies recommended for everyone are in the box below. Other preventive efforts range from removing or flattening plaque in the carotid arteries to taking warfarin for atrial fibrillation, closing a hole in the heart, or taking aspirin or other antiplatelet medication.

The important thing to remember about a TIA is that it isn't a minor problem to deal with later. Although the symptoms fade, the root cause remains. Finding that cause, and dealing with it as soon as possible, can prevent a larger and possibly disabling or deadly stroke.

— Karen L. Furie, M.D. Associate Professor of Neurology, Harvard Medical School

(Editor's note: Dr. Furie was a member of the panel that developed the guidelines on stroke prevention mentioned above. You can see the entire document at www.health.harvard.edu/101 .)

Last updated:	September 05, 2008