Transient Ischemic Attack (TIA, Mini-Stroke) - Prognosis

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What is the prognosis for transient ischemic attack (TIA)?

A transient ischemic attack should be considered a major warning sign of an impending future stroke. Up to 10% of people will experience a stroke within three months of TIA. Since there is no way of predicting that stroke-like symptoms will resolve, the patient and family need to be educated should symptoms occur, they need to access medical care emergently activating the emergency medical services system and calling 911.

If a stroke occurs, there is a very short period of time where thrombolytic (clot dissolving) drugs, (for example, alteplase [TPA]), can be used to reverse a stroke. In most hospitals, the drug can only be given within 4 1/2 hours of onset of stroke symptoms. In that time frame, the patient needs to get to the hospital, the diagnosis needs to be made, laboratory tests and head CT scans need to be performed, neurologic consultation needs to occur, and the drug administered. The longer the delay, there is a higher the risk that the drug won't work and that complications such as bleeding into the brain will occur.

Specialized interventional radiologists can inject TPA directly into the clot that has blocked the blood vessel in the brain. This can extend the time frame to six hours, but currently this treatment is not widely available.

TIAs should be considered the equivalent of angina of the brain. In heart disease, angina is the heart pain that warns of potential heart attack. When heart muscle is damaged, it cannot be replaced or repaired. Similarly, brain tissue is at risk when there is decreased blood supply and it, too, cannot be replaced.

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