One of the most serious warning signs of a stroke is a transient ischemic attack, or TIA.
Learn more about the symptoms of a TIA and what to do if you experience one from Dr. Brad Worrall, a UVA stroke specialist
Selected Podcast
Stroke Warning Sign: What is a TIA?
Featured Speaker:
Brad Worrall, MD
Dr. Brad Worrall is a board-certified neurologist who specializes in stroke care, including transient ischemic attacks. Transcription:
Stroke Warning Sign: What is a TIA?
Melanie Cole (Host): One of the most serious warning signs of a stroke is a transient ischemic attack or TIA. What are those symptoms that you should really be aware of so that you can get the help you need as quickly as possible. My guest is Dr. Brad Worrall. He’s a board-certified neurologist who specializes in stroke care including transient ischemic attacks. Welcome to the show, Dr. Worrall. Tell us a little bit about what a TIA is and what are those symptoms that people really need to be aware of?
Dr. Brad Worrall (Guest): Good morning. Thank you for having me. A TIA should be considered a warning for a stroke and therefore the symptoms of a TIA are exactly the same as what you might expect with a stroke. These symptoms would be weakness, numbness, clumsiness, loss of vision in one eye or on one side, and these symptoms would be things that come on very suddenly like a light switch being thrown.
Melanie: What do you do? People think, oh, they just had too much to drink, their speech is slurred or they’re… people don’t catch these symptoms may be right away. Who would be more likely to catch the symptoms: the persons suffering them or the people they are with?
Dr. Worrall: Actually, it can go either way. A patient experiencing a TIA may be talking and all of a sudden their speech comes out garbled, or they’re trying to prepare a meal and all of a sudden their hand isn’t working. So they may be the first to be aware of it. However, some of the symptoms of stroke and TIA can actually make recognizing that that’s what’s going on difficult, so as you said, somebody slurring their speech may be interpreted as being tired or being drunk or being confused. There is a form of stroke symptom called neglect where you actually are not even aware that there’s anything wrong.
Melanie: These are sometimes called mini-strokes, these TIAs. Is it going to lead automatically to a much larger stroke or can they be little warning signs that would build up to that?
Dr. Worrall: Excellent question. I am somebody who does not like the term mini-stroke because mini implies small and these are not necessarily small at all. A TIA may come on with all of the symptoms that would be present in a stroke and the thing that is important is they go away, and that is what distinguishes a TIA from a stroke. We used to think that TIAs were a good thing. “You know, you almost had a stroke, but you didn’t, that’s great,” pat someone on the head and say, “Go home. Come back in a couple of days and we’ll figure out why this happened.” Well, indeed, we found out that TIAs are a very grave warning sign and that the risk of having a stroke or dying in the next two days is greatest and so therefore we most frequently admit people with TIA to the hospital to evaluate them very rapidly to figure out why and try to prevent that threatened stroke.
Melanie: So it sounds like it’s just such a great red flag for physicians to be able to see this and hopefully get at it as opposed to a major stroke that happens with no warning and then you have to treat. How do you treat a TIA and what are you looking for?
Dr. Worrall: Well, if the symptoms are still going on, it’s impossible to know whether the symptoms will be transient or permanent. The initial evaluation is identical to what we might do if somebody is in the midst of having a stroke. Check, make sure the person is stable, blood pressure, breathing, etcetera, and then rapid neurologic examination to determine if there are any lingering problems. As we talked about, the patient themselves may not be aware of everything. They may think everything has gotten better, but perhaps it has not and that would be very important because we do have the clot buster that we can use to try to reverse a stroke that’s in the process of happening. If the symptoms have completely resolved, then it’s still important to get a picture of the brain to see if there has been any permanent damage. Because even if the symptoms go away, there could be damage done to the brain.
Then the final, crucial part is to look for the mechanism or cause of the TIA. That may be hardening of the arteries, atherosclerosis causing a blockage in the neck. That is one of the more common causes of TIA and potentially a very devastating cause of stroke. It can be caused by atrial fibrillation, an irregular heartbeat that allows a blood clot to form in the heart. It can then break loose and go up and block a blood vessel in the brain. There are other mechanisms of stroke that we would also need to identify and rapidly start medication to try to lower the risk of stroke in that person that’s presented with a TIA. That would include things like aspirin or other medications that make the platelet, little cell fragments in the blood that can stick together and cause a clot from being so sticky; treating risk factors like hypertension, diabetes, high cholesterol; counseling patient to stop smoking which is one of the most modifiable risk factor for stroke. Then if there are one of these specific causes that I mentioned such as hardening of the artery in the neck which would be treated most commonly by either surgery to remove that blockage or using a stent to try to open that blockage up. Or if the patient has been determined to have atrial fibrillation, instead of using antiplatelet agent, a blood thinner such as Coumadin or one of the newer agents to dramatically reduce the risk of stroke in the setting of atrial fibrillation would be of great import.
Melanie: You’ve given us such great information. If you feel that someone is suffering a TIA or you yourself are, is it the same as having a stroke? Do you want them to call 911 and time is brain. Does all of that apply for a TIA?
Dr. Worrall: Absolutely. Again, as I said, because we don’t know whether the symptoms are indeed completely gone or how quickly they might return, I mentioned that the period of greatest risk is actually in the first two days and we think that risk is greater closer to the TIA. The faster you get to the hospital, the better chance you have of catching somebody before they go on to have a stroke. I would absolutely encourage anyone who thinks they might be having a TIA to call 911 and get to the emergency room immediately. It is very important to go to the emergency room. You can call your primary care provider or your neurologist, if you have one, once you get there. Because again if the symptoms come back, you may not be able to communicate any longer and it is of crucial importance that people get to the emergency room.
Melanie: In just the last minute or so, Dr. Worrall, would you please give the listeners your best advice on prevention or recognizing TIA and why patients should come to the UVA Stroke Center for their care.
Dr. Worrall: I’ll take that in three parts. The recognition, as I’ve said, anything that affects particularly one side of the body, particularly coming on suddenly, so weakness, numbness, clumsiness, loss of vision, difficulty speaking or difficulty being understood. Any of those symptoms that come on suddenly without an explanation should be considered stroke symptom and potential TIA and should get to the hospital immediately. Prevention, I talked about some of the risk factors that are important for stroke and TIA. High blood pressure, we know that lowering blood pressure as little as three to five points can substantially lower the risk of having a stroke. Diabetes, high cholesterol, smoking, atrial fibrillation, these are all modifiable risk factors that patients and their doctors can work together to try to lower their stroke risk. At the University of Virginia, we have been providing acute stroke care for decades. It’s a highly specialized team that involves everyone from pre-hospital, ambulance providers, all the way through the inpatient stroke service, the neuro critical care unit, and to our rehab hospital. There is a comprehensive care provided at UVA for stroke patients. Anyone with a TIA or stroke should come to the University of Virginia for rapid evaluation. Time is brain. It is absolutely crucial that we get the opportunity to try to reverse any damage that’s in the process of happening.
Melanie: Thank you so much. For more information on the UVA Stroke Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Healthy Systems Radio. This is Melanie Cole. Thanks so much for listening.
Stroke Warning Sign: What is a TIA?
Melanie Cole (Host): One of the most serious warning signs of a stroke is a transient ischemic attack or TIA. What are those symptoms that you should really be aware of so that you can get the help you need as quickly as possible. My guest is Dr. Brad Worrall. He’s a board-certified neurologist who specializes in stroke care including transient ischemic attacks. Welcome to the show, Dr. Worrall. Tell us a little bit about what a TIA is and what are those symptoms that people really need to be aware of?
Dr. Brad Worrall (Guest): Good morning. Thank you for having me. A TIA should be considered a warning for a stroke and therefore the symptoms of a TIA are exactly the same as what you might expect with a stroke. These symptoms would be weakness, numbness, clumsiness, loss of vision in one eye or on one side, and these symptoms would be things that come on very suddenly like a light switch being thrown.
Melanie: What do you do? People think, oh, they just had too much to drink, their speech is slurred or they’re… people don’t catch these symptoms may be right away. Who would be more likely to catch the symptoms: the persons suffering them or the people they are with?
Dr. Worrall: Actually, it can go either way. A patient experiencing a TIA may be talking and all of a sudden their speech comes out garbled, or they’re trying to prepare a meal and all of a sudden their hand isn’t working. So they may be the first to be aware of it. However, some of the symptoms of stroke and TIA can actually make recognizing that that’s what’s going on difficult, so as you said, somebody slurring their speech may be interpreted as being tired or being drunk or being confused. There is a form of stroke symptom called neglect where you actually are not even aware that there’s anything wrong.
Melanie: These are sometimes called mini-strokes, these TIAs. Is it going to lead automatically to a much larger stroke or can they be little warning signs that would build up to that?
Dr. Worrall: Excellent question. I am somebody who does not like the term mini-stroke because mini implies small and these are not necessarily small at all. A TIA may come on with all of the symptoms that would be present in a stroke and the thing that is important is they go away, and that is what distinguishes a TIA from a stroke. We used to think that TIAs were a good thing. “You know, you almost had a stroke, but you didn’t, that’s great,” pat someone on the head and say, “Go home. Come back in a couple of days and we’ll figure out why this happened.” Well, indeed, we found out that TIAs are a very grave warning sign and that the risk of having a stroke or dying in the next two days is greatest and so therefore we most frequently admit people with TIA to the hospital to evaluate them very rapidly to figure out why and try to prevent that threatened stroke.
Melanie: So it sounds like it’s just such a great red flag for physicians to be able to see this and hopefully get at it as opposed to a major stroke that happens with no warning and then you have to treat. How do you treat a TIA and what are you looking for?
Dr. Worrall: Well, if the symptoms are still going on, it’s impossible to know whether the symptoms will be transient or permanent. The initial evaluation is identical to what we might do if somebody is in the midst of having a stroke. Check, make sure the person is stable, blood pressure, breathing, etcetera, and then rapid neurologic examination to determine if there are any lingering problems. As we talked about, the patient themselves may not be aware of everything. They may think everything has gotten better, but perhaps it has not and that would be very important because we do have the clot buster that we can use to try to reverse a stroke that’s in the process of happening. If the symptoms have completely resolved, then it’s still important to get a picture of the brain to see if there has been any permanent damage. Because even if the symptoms go away, there could be damage done to the brain.
Then the final, crucial part is to look for the mechanism or cause of the TIA. That may be hardening of the arteries, atherosclerosis causing a blockage in the neck. That is one of the more common causes of TIA and potentially a very devastating cause of stroke. It can be caused by atrial fibrillation, an irregular heartbeat that allows a blood clot to form in the heart. It can then break loose and go up and block a blood vessel in the brain. There are other mechanisms of stroke that we would also need to identify and rapidly start medication to try to lower the risk of stroke in that person that’s presented with a TIA. That would include things like aspirin or other medications that make the platelet, little cell fragments in the blood that can stick together and cause a clot from being so sticky; treating risk factors like hypertension, diabetes, high cholesterol; counseling patient to stop smoking which is one of the most modifiable risk factor for stroke. Then if there are one of these specific causes that I mentioned such as hardening of the artery in the neck which would be treated most commonly by either surgery to remove that blockage or using a stent to try to open that blockage up. Or if the patient has been determined to have atrial fibrillation, instead of using antiplatelet agent, a blood thinner such as Coumadin or one of the newer agents to dramatically reduce the risk of stroke in the setting of atrial fibrillation would be of great import.
Melanie: You’ve given us such great information. If you feel that someone is suffering a TIA or you yourself are, is it the same as having a stroke? Do you want them to call 911 and time is brain. Does all of that apply for a TIA?
Dr. Worrall: Absolutely. Again, as I said, because we don’t know whether the symptoms are indeed completely gone or how quickly they might return, I mentioned that the period of greatest risk is actually in the first two days and we think that risk is greater closer to the TIA. The faster you get to the hospital, the better chance you have of catching somebody before they go on to have a stroke. I would absolutely encourage anyone who thinks they might be having a TIA to call 911 and get to the emergency room immediately. It is very important to go to the emergency room. You can call your primary care provider or your neurologist, if you have one, once you get there. Because again if the symptoms come back, you may not be able to communicate any longer and it is of crucial importance that people get to the emergency room.
Melanie: In just the last minute or so, Dr. Worrall, would you please give the listeners your best advice on prevention or recognizing TIA and why patients should come to the UVA Stroke Center for their care.
Dr. Worrall: I’ll take that in three parts. The recognition, as I’ve said, anything that affects particularly one side of the body, particularly coming on suddenly, so weakness, numbness, clumsiness, loss of vision, difficulty speaking or difficulty being understood. Any of those symptoms that come on suddenly without an explanation should be considered stroke symptom and potential TIA and should get to the hospital immediately. Prevention, I talked about some of the risk factors that are important for stroke and TIA. High blood pressure, we know that lowering blood pressure as little as three to five points can substantially lower the risk of having a stroke. Diabetes, high cholesterol, smoking, atrial fibrillation, these are all modifiable risk factors that patients and their doctors can work together to try to lower their stroke risk. At the University of Virginia, we have been providing acute stroke care for decades. It’s a highly specialized team that involves everyone from pre-hospital, ambulance providers, all the way through the inpatient stroke service, the neuro critical care unit, and to our rehab hospital. There is a comprehensive care provided at UVA for stroke patients. Anyone with a TIA or stroke should come to the University of Virginia for rapid evaluation. Time is brain. It is absolutely crucial that we get the opportunity to try to reverse any damage that’s in the process of happening.
Melanie: Thank you so much. For more information on the UVA Stroke Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Healthy Systems Radio. This is Melanie Cole. Thanks so much for listening.