By Debra Zara, RHIA, Maxim Healthcare Staffing
The Merck Manual defines transient ischemic attacks (TIA) as focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of blood through the internal carotid, middle cerebral or the vertebrobasilar arterial system. Most TIAs are due to cerebral emboli from ulcerated plaques in the carotid or vertebral arteries in the neck.
Risk Factors associated with TIA are:
- Increases after age 45 with the greatest risk in the 70’s and 80’s
- Male 3:1 greater risk than females
- Family history increases risk
- Hypertension
- Underlying cardiac disease
- Smoking
- Diabetes
- Hypercholesterolemia
- Atrial fibrillation
- Hypercoagulable states
- Spontaneous/posttraumatic
TIAs begin suddenly, last 2-to-30 minutes, then lessen without persistent neurological abnormalities; consciousness remains intact throughout the episode.
The clinical indicators of TIA differ based on the location of the compromised blood flow. If the blood flow location compromised is carotid circulation, the indicators are:
- Hemispheric monocular vision loss
- Hemiplegia
- Hemianesthesia
- Aphasia
- Headaches
- Seizure
- Amnesia
- Confusion
If the blood flow location compromised is vertebrobasilar circulation, the indicators are:
- Brainstem/cerebellar bilateral visual obscuration
- Vertigo
- Ataxia
- Facial paresis
- Dysphagia
- Dysarthria
- Headache
- Nausea
- vomiting
TIAs are diagnosed with:
- Labs such as INR and PTT
- Imaging such as Carotid US, ECG, Angiography of the cerebral and/or carotid arteries, Holter monitoring, CT of the head during the acute phase, Brain MRI, EEG to differentiate between TIA and seizure
- Physician opinion
TIAs are treated with:
- Drugs such as Aspirin, Plavix, Aggrenox, and Warfarin
- Surgery such as carotid stenting or carotid endarterectomy
References:
Harrison’s Principles of Internal Medicine, 17 edition, 2008; chapter 364
Dorland’s Medical Dictionary
The Merck Manual, 2007, Chapter 174/Section 14
J.A. Thomas and Associates, Inc., 2009
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