1. Understanding Stroke Slideshow Pictures
2. Take the Stroke Quiz
3. Atrial Fibrillation Slideshow: Causes, Tests and Treatment

Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Transient ischemic attack (TIA) facts
• What is a transient ischemic attack (TIA)?
• What are the causes of transient ischemic attack (TIA)?
• What are the risk factors for transient ischemic attack (TIA)?
• What are the symptoms of transient ischemic attack (TIA)?
• How is transient ischemic attack (TIA) diagnosed?
• What is the treatment for transient ischemic attack (TIA)?
• What is the prognosis for transient ischemic attack (TIA)?
• Patient Comments: Transient Ischemic Attack (TIA, Mini-Stroke) - Symptoms
• Transient Ischemic Attack (TIA, Mini-Stroke) Index

TIA Therapy

Treatment for a transient ischemic attack is aimed at preventing a second stroke. Since there is no way of determining the severity of future episodes, and no guarantee that the symptoms will resolve, prevention of a future TIA or CVA is crucial.

Treatment guidelines address a variety of targeted goals.

Antiplatelet therapy

• If the patient was not taking aspirin when the TIA occurred, it usually is started at a dose of 325mg per day.
• If the patient was taking aspirin, another antiplatelet drug called dipyridamole may be added. Aggrenox is a combination of aspirin and dipyridamole. Headache is often a side effect.
• If the patient cannot tolerate aspirin because of allergy or stomach upset clopidogrel (Plavix) may be used.

High blood pressure therapy

• Even if the patient does not have hypertension or high blood pressure, there may be benefit in taking anti-hypertensive medications.  
• Two classes of drugs are recommended to be started at the same time, a diuretic and an ACE inhibitor.
• The goal for normal blood pressure is 120/80.

Cholesterol lowering therapy

• Guidelines recommend that a statin drug be started, even if cholesterol levels are normal. Simvastatin (Zocor) is the most commonly recommended medication, but new guidelines limit the amount prescribed per day because of the risk of liver side effects.

Risk modification

Smoking, excessive alcohol, obesity and lack of physical activity are considered risks for future stroke. The following recommendations are now suggested:

• Smoking: Counseling, smoking cessation aids like nicotine gum or medications like varenicline (Chantix) should be considered. Environmental smoke should be avoided.
• Alcohol: Intake should be limited to two or fewer drinks a day for men and one or less for women.
• Obesity: Overweight people should try to lose weight using a combination of diet, exercise and counseling. The goal is a BMI of 18.5-24.9 and a waist line of 35 inches or less for women and 40 inches or less for men.
• Exercise: 30 minutes of moderate exercise daily is recommended for those who are able. For patients with disabilities, a tailored exercise program to their capabilities should be arranged.