Description

• Transient episode of neurologic dysfunction due to focal brain, retinal, or spinal cord ischemia without acute infarction
• 7.5–17.4% of patients with transient ischemic attack (TIA) experience a stroke within 3 months (1).
• Synonym: ministroke

Epidemiology

Etiology and Pathophysiology

Temporary reduction/cessation of cerebral blood flow adversely affecting neuronal function; common subtypes:

• Embolic from unknown source (36%)
• Cardioembolic events (29%):
  • Valvular pathology; mural hypokinesias with thrombosis
  • Atrial fibrillation (AFib): 5–20% incidence
• Large artery atherothrombosis (16%)
• Small vessel ischemic diseases (16%)
• Uncommon causes (3%): arterial dissection, hypercoagulable states, vasculitis, vasospasms, or sickle cell occlusive disease

Risk Factors

• Older age (i.e., >60 years)
• HTN, cardiac diseases (AFib, MI, valvular disease)
• Atherosclerotic disease (carotid/vertebral stenosis)
• Obesity, diabetes mellitus (DM), hyperlipidemia
• Cigarette smoking
• Thrombophilias

General Prevention

• Strict control of DM, HTN, hyperlipidemia
• Anticoagulation when high risk of cardioembolism (e.g., AFib, mechanical valves)
• Antiplatelet therapy for preventing recurrence, if previous TIA (2)

Geriatric Considerations

• Older patients have a higher mortality rate—highest in 7th and 8th decades of life.
• AFib is a frequent cause.

Pediatric Considerations

• Congenital heart disease is a common cause.
• Genetic: Marfan syndrome, moyamoya, or sickle cell disease

Pregnancy Considerations

• Preeclampsia, eclampsia, and HELLP syndrome
• Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome
• Hypercoagulable states related to pregnancy

Commonly Associated Conditions

• AFib, uncontrolled HTN, carotid stenosis
• Some disease processes mimic TIA presentation (seizures, migraines, metabolic disturbances, syncope, multiple sclerosis); difference: gradual onset with nonspecific symptoms (headache, memory loss) versus acute onset with specific neurologic deficits (TIA)