Overview

Symptoms

The symptoms of a transient ischaemic attack (TIA) are the same as those of a stroke, but they only last for a few minutes or hours.

Recognising the signs of a TIA

Like a stroke, the signs and symptoms of a TIA usually begin suddenly.

It’s important to recognise the symptoms quickly and call 999 to ask for an ambulance straight away.

The main symptoms can be remembered with the word FAST:

• Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have drooped.
• Arms – the person may not be able to lift both arms and keep them there, because of weakness or numbness in 1  arm.
• Speech – their speech may be slurred or garbled, or the person may not be able to talk at all, despite appearing to be awake; they may also have problems understanding what you’re saying to them.
• Time – it's time to dial 999 immediately if you notice any of these signs or symptoms.

It's important for everyone to be aware of these signs and symptoms.

If you live with or care for someone in a high-risk group, such as an elderly person or someone with diabetes or high blood pressure, being aware of the symptoms is even more important.

Other possible symptoms

The symptoms in the FAST test identify most strokes and TIAs, but a TIA can occasionally cause different symptoms that typically appear suddenly (usually over a few seconds).

Other signs and symptoms may include:

• complete paralysis of one side of the body
• sudden vision loss, blurred vision or double vision
• vertigo
• being sick
• dizziness
• confusion
• difficulty understanding what others are saying
• problems with balance and co-ordination 
• difficulty swallowing (dysphagia)

However, there may be other causes for these symptoms.

When to get medical advice

Call 999 immediately and ask for an ambulance if you or someone else has symptoms of a TIA or stroke.

If a TIA is suspected, you will be offered aspirin to take straigh taway. This helps to prevent a stroke.

Even if the symptoms disappear while you're waiting for the ambulance to arrive, an assessment in a hospital should still be done.

You should be referred to see a specialist within 24 hours of the start of your symptoms.

A TIA is a warning that you're at risk of having a full stroke in the near future. An assessment can help doctors determine the best way to reduce the chances of this happening.

If you think you've had a TIA previously, but the symptoms have since passed and you did not get medical advice at the time, make an urgent appointment with a GP. They can refer you for a hospital assessment, if appropriate.

Who can get it

Transient ischaemic attacks (TIAs) happen when one of the blood vessels that supply your brain with oxygen-rich blood becomes blocked.

This interruption in the flow of blood to the brain means it cannot do some of its normal functions properly, leading to symptoms such as slurred speech and weakness.

In TIAs, the blockage quickly resolves and your brain's blood supply returns to normal before there's any significant damage. In a full stroke, the blood flow to your brain is disrupted for much longer, leading to more severe damage to the brain and longer-term problems.

The blockage in the blood vessels responsible for most TIAs is usually caused by a blood clot that's formed elsewhere in your body and travelled to the blood vessels supplying the brain. It can also be caused by pieces of fatty material or air bubbles.

In very rare cases, a TIA can be caused by a small amount of bleeding in the brain known as a haemorrhage.

Blood clots

Blood clots that cause TIAs may form in areas where arteries have been narrowed or blocked over time by the build-up of fatty deposits known as plaques. These plaques are formed during a process called atherosclerosis.

As you get older, your arteries can naturally become narrower, but certain things can dangerously speed up this process. These include:

• smoking
• high blood pressure (hypertension)
• obesity
• high cholesterol levels
• diabetes
• excessive alcohol consumption

A type of irregular heartbeat called atrial fibrillation can also cause a TIA. It can lead to the formation of blood clots that escape from the heart and become lodged in the blood vessels supplying the brain.

Who's most at risk?

Certain things can increase your chances of having a TIA. Some of these factors are changeable – such as your lifestyle.

Some of the main risk factors for TIA are:

• age – although TIAs can occur at any age (including in children and young adults), they're most common in people over 55
• ethnicity – people of south Asian, African or Caribbean descent have a higher TIA risk, partly because rates of diabetes and high blood pressure are higher in these groups
• medical history – other health conditions such as diabetes can increase your risk of a TIA
• weight and diet – your risk of having a TIA is higher if you're overweight and/or have an unhealthy diet high in fat and salt
• smoking and alcohol – smoking and/or regularly drinking excessive amounts of alcohol can increase your TIA risk

Tackling the things you can change will help to lower your risk of having a TIA, or reduce your chances or having a full stroke in the future.

Diagnosis

It's important to be assessed by a healthcare professional as soon as possible if you think you've had a transient ischaemic attack (TIA).

After an initial assessment, you will be referred to a specialist for further tests to help determine the cause of the TIA. You should be referred to see a specialist within 24 hours of the start of your symptoms.

Initial assessment

TIAs are often over very quickly, so you may not have any symptoms by the time you see a doctor.

If they suspect you’ve had a TIA, you’ll be given aspirin to take straight  away to prevent a stroke. You’ll also be referred to a specialist for further tests.

Specialist assessment

You'll usually be seen by a doctor who specialises in conditions that affect the brain and spine (neurologist), or a consultant who specialises in strokes. This may be in a specialist stroke or TIA clinic, or an acute stroke unit.

You'll be asked about the symptoms you experienced during the TIA and how long they lasted. This will help to rule out other conditions that may have caused your symptoms.

Even if you no longer have symptoms, you may still need a neurological examination. This involves simple tasks designed to check your strength, sensation and co-ordination skills.

Tests

Several tests may be done to confirm a TIA and look for problems that may have caused it. Some of these tests include:

Blood pressure tests

Your blood pressure will be checked, because high blood pressure (hypertension) can lead to TIAs.

Blood tests

You might need blood tests to check whether you have high cholesterol or diabetes.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures your heart's electrical activity using a number of electrodes (small, sticky patches) attached to your skin.

An ECG can detect abnormal heart rhythms, which may be a sign of conditions such as atrial fibrillation (where your heart beats irregularly), which can increase your risk of TIAs.

Carotid ultrasound

A carotid ultrasound scan can show if there is narrowing or any blockages in the neck arteries leading to your brain.

A small probe (transducer) sends high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.

Brain scans

Brain scans are not always necessary if you've had a TIA. They're usually  only done if it's not clear which part of your brain was affected.

An MRI scan is most often used. This type of scan uses a strong magnetic field and radio waves to create an image of your brain.

Treatment

Although the symptoms of a transient ischaemic attack (TIA) resolve in a few minutes or hours without any specific treatment, you'll need treatment to help prevent another TIA or a full stroke from happening in the future.

A TIA is a warning sign that you're at increased risk of having a full stroke in the near future. The highest risk is in the days and weeks following the TIA.

A stroke is a serious health condition that can cause permanent disability and can be fatal in some cases, but appropriate treatment after a TIA can help to reduce your risk of having a stroke.

Your treatment will depend on your individual circumstances, such as your age and medical history. Your healthcare team can discuss treatment options with you, and tell you about possible benefits and risks.

Treatments include:

• lifestyle changes
• medicines
• surgery

Lifestyle changes

There are a number of lifestyle changes you can make that may help to reduce your chances of having a stroke after a TIA.

These include:

• eating a healthy, balanced diet – a low-fat, reduced-salt, high-fibre diet is usually recommended, including plenty of fresh fruit and vegetables
• exercising regularly – for most people this means at least 150 minutes of moderate-intensity activity, such as cycling or fast walking, or 75 minutes of vigorous-intensity activity such as running, swimming, or riding a bike up a hill, every week. Plus, strength exercises on 2 days every week
• stopping smoking – if you smoke, stopping may significantly reduce your risk of having a stroke in the future
• cutting down on alcohol – men and women are advised to limit alcohol intake to 14 units per week

Medicines

Most people who have had a TIA will need to take 1 or more medicines every day, long-term, to help reduce their chances of having a stroke or another TIA.

Aspirin and other antiplatelet medicines

You’ll probably be given aspirin straightaway after a suspected TIA.

Aspirin works as an antiplatelet medicine.

Platelets are blood cells that help blood to clot.

Antiplatelet medicines work by reducing the ability of the platelets to stick together and form clots.

You may also be given other antiplatelets such as clopidogrel or dipyridamole.

The main side effects of antiplatelet medications include indigestion and an increased risk of bleeding. For example, you may bleed for longer if you cut yourself and you may bruise easily.

Anticoagulants

Anticoagulant medicines can help to prevent blood clots by changing the chemical composition of the blood in a way that stops clots from forming.

They're usually offered to people who had a TIA that was caused by a blood clot in their heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly.

Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants that may be offered to some people who have had a TIA.

A side effect of all anticoagulants is the risk of bleeding because these medicines reduce the blood's ability to clot. You may need regular blood tests while taking warfarin, so doctors can check your dose is not too high or too low.

Find out more about anticoagulants.

Blood pressure medicines

If you have high blood pressure (hypertension) you'll be offered a type of medicine called an antihypertensive to control it. This is because high blood pressure increases your risk of having a TIA or stroke.

There are lots of different types of medicine that can help control your blood pressure, including:

• thiazide diuretics
• angiotensin-converting enzyme (ACE) inhibitors
• calcium channel blockers
• beta-blockers

Your doctor will advise you about which antihypertensive is the most suitable for you. Some people may be offered a combination of 2 or more different medicines.

Read more about treating high blood pressure.

Statins

If you have high cholesterol, you'll be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme in the liver that produces cholesterol.

Statins may also help to reduce your risk of a stroke whatever your cholesterol level is. You may be offered a statin even if your cholesterol level is not particularly high.

Examples of statins often given to people who have had a TIA include atorvastatin, simvastatin and rosuvastatin.

Read more about statins.

Surgery

In some cases, an operation called a carotid endarterectomy may be recommended after having a TIA.

Carotid endarterectomy

A carotid endarterectomy is an operation that involves removing part of the lining of the carotid arteries – the main blood vessels that supply the head and neck – plus any blockage inside the carotid arteries.

When fatty deposits build up inside the carotid arteries, the arteries become hard and narrow, making it more difficult for blood to flow to your brain.

This is known as atherosclerosis and it can lead to TIAs and strokes if the blood supply to the brain becomes disrupted.

By unblocking the carotid arteries when they have become moderately or severely narrowed, a carotid endarterectomy can significantly reduce the risk of having a stroke or another TIA.

Find out more about a carotid endarterectomy.

Driving after a TIA

Although a TIA should not have a long-term impact on your daily activities, you must stop driving immediately.

If your doctor is happy that you have made a good recovery and there are no lasting effects after 1 month, you can start driving again.

If you’re a car driver then you do not need to inform the Driver and Vehicle Licensing Agency (DVLA), but you should contact your car insurance company.

You will need to contact the DVLA if you hold a bus or lorry licence.

GOV.UK has more information about telling the DVLA about a medical condition or disability.

Prevention

The best way to help prevent a TIA is to eat a healthy diet, exercise regularly and not smoke or drink too much alcohol.

These lifestyle changes can reduce your risk of problems such as your ateries becoming clogged by fatty substances (atherosclerosis), high blood pressure and high cholesterol levels, all of which can lead to TIAs.

If you have already had a TIA, making these changes can help to reduce your risk of having a full stroke or another TIA in the future.

Diet

An unhealthy diet can increase your chance of having a TIA or stroke because it may raise your blood pressure and cholesterol level.

A low-fat, high-fibre diet is usually recommended, including at least 5 portions of fresh fruit and vegetables each day, plus wholegrains.

Making sure you eat a balanced diet is important. Do not eat too much of any single food, particularly processed foods and foods high in salt.

You should limit the amount of salt you eat to no more than 6g a day because too much salt will increase your blood pressure – 6g of salt is about 1 teaspoon.

Read more about healthy eating

Exercise

Combining a healthy diet with regular exercise is the best way to maintain a healthy weight.

Regular exercise can also help to lower your cholesterol level and keep your blood pressure in a safe range.

For most people, at least 150 minutes (2 hours and 30 minutes) of moderate-intensity activity, such as cycling or fast walking, or 75 minutes of vigorous-intensity activity such as running, swimming, or riding a bike up a hill, every week is recommended. Doing strength exercises on 2 days every week is also recommended.

Find out more about exercise.

Stop smoking

Smoking significantly increases your risk of having a TIA or stroke. This is because it narrows your arteries and makes your blood more likely to clot.

If you stop smoking, you can reduce your risk of having a TIA or stroke.

Not smoking will also improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease.

Help Me Quit can help you to give up smoking. Visit their website or call them on 0800 250 6885.

Read more about stopping smoking.

Cut down on alcohol

Excessive alcohol consumption can lead to weight gain, high blood pressure, and an irregular heartbeat (atrial fibrillation), all of which can increase your risk of having a TIA or stroke.

To keep health risks from alcohol to a low level if you drink most weeks:

• men and women are advised not to drink more than 14 units a week on a regular basis
• spread your drinking over 3 or more days if you regularly drink as much as 14 units a week
• if you want to cut down, have several drink-free days each week

Find out more about managing alcohol.

Managing underlying conditions

If you've been diagnosed with a condition that's known to increase your risk of TIAs and strokes, such as high cholesterol, high blood pressure, atrial fibrillation or diabetes, it's important to control the condition.

Llifestyle changes can help control these conditions to a large degree, but you may also need to take regular medicine.

Find out more about:

• treating high cholesterol
• treating high blood pressure
• treating atrial fibrillation
• treating type 1 diabetes and treating type 2 diabetes