What is a Transient Ischemic Attack?
Transient Ischemic Attack (TIA)
A stroke happens when a blood vessel in the brain is blocked (an ischemic stroke) or bursts (a hemorrhagic stroke). Either way, the parts of the brain that depend on that blood vessel can be damaged or die. Strokes can be disabling and can cause significant neurological problems.
A transient ischemic attack, or TIA, is often called a “mini-stroke.” It is usually caused by a blood clot, but the blood flow is blocked only briefly, often for just a few minutes, and the symptoms go away. TIA symptoms look just like a stroke and need to be treated as a medical emergency. A TIA is a warning sign of a possible future stroke. Up to 15% of people who have a TIA have a major stroke within three months, and many of those strokes happen within the first few days (1).
If you notice any stroke symptoms, even if they go away, call 911 right away.
How Common Are TIAs and Strokes?
About 800,000 people have a stroke each year in the U.S. About 1 in 3 people who have a TIA will eventually have a stroke without treatment to lower their risk (2).
What Are the Symptoms of a TIA?
The American Stroke Association uses the letters FAST to help people recognize a stroke or TIA (3):
Face drooping. Ask the person to smile and see if one side droops.
Arm weakness. Ask the person to raise both arms and see if one drifts down.
Speech difficulty. Is speech slurred, hard to understand or absent?
Time to call 911. If any of these signs appear, even if they go away, call 911 and get to the hospital right away.
Other sudden signs of stroke include:
Numbness or weakness of the face, arm or leg, especially on one side of the body
Confusion, trouble speaking or trouble understanding speech
Trouble seeing in one or both eyes, or in part of the field of vision
Trouble walking, dizziness, or loss of balance or coordination
A severe headache with no known cause
Any of these should be treated as a medical emergency. Call 911 (3).
What Are the Risk Factors for a TIA?
TIAs and strokes share the same risk factors. High blood pressure is one of the biggest. Other risk factors include high cholesterol, diabetes, an irregular heart rhythm called atrial fibrillation, smoking, excess weight, lack of exercise, an unhealthy diet and heavy alcohol use. Stroke risk is also higher in some groups, including Black adults (4). Many of these risk factors can be managed with your physician’s help.
What Happens in the Brain During a TIA?
The brain is made of many types of cells. The ones we usually think of as brain cells are neurons. To survive, neurons need a constant blood supply to deliver oxygen and glucose.
In a TIA, this blood supply is interrupted only briefly, and symptoms usually last less than an hour (5). By definition, a TIA doesn’t cause lasting damage that shows up on brain imaging. In a full stroke, the interruption lasts longer and sets off a chain reaction called the ischemic cascade. The cell’s energy production fails, and a flood of a brain chemical called glutamate pushes neurons to fire faster than they can keep up with. This produces damaging molecules called free radicals and lets calcium rush into the cell, breaking down its proteins and eventually killing the neuron (6). The walls of blood vessels can also break down, damaging the blood-brain barrier and causing brain swelling (5).
Even though a TIA’s symptoms go away, some people notice lingering problems afterward, such as fatigue, trouble concentrating, or feeling off-balance.
How Is a TIA Diagnosed?
A physical and neurological exam can reveal signs of a TIA or stroke, such as changes in walking or speech. MRI and CT help look for brain injury and the blood vessels involved, and MRI is often preferred because it can show whether any brain injury has occurred (5). Tests of the heart and blood vessels, along with lab tests such as cholesterol levels, help find the cause.
How Is a TIA Usually Treated?
In a sudden stroke, emergency treatment may be needed to break up or remove a blood clot, stabilize a blood vessel or relieve pressure on the brain. By the time a TIA is diagnosed, the blockage has usually cleared, so treatment focuses on lowering the risk of another TIA or a stroke. Medications to reduce clotting, lower blood pressure and lower cholesterol are commonly used (7).
When a stroke leaves lasting movement, thinking or other neurological problems, these are usually treated with physical, occupational and speech therapy. These therapies are very helpful. As recovery slows, many programs shift more toward teaching people ways to work around lost abilities. Our care focuses on continuing to look for ways to improve function in the systems that remain.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician, neurologist and stroke prevention team, never in place of them. Please don’t change or stop any medication, including blood thinners, blood pressure or cholesterol medication, without talking with your prescriber.
After a TIA, our evaluation looks closely for any lingering problems with balance, vision, coordination or thinking, and we review your risk factors so we can help you work with your physician to lower them. After a stroke, our care focuses on rehabilitation.
One important idea in stroke recovery is called diaschisis. Nerve cells need three main things to stay healthy: glucose, oxygen and activity. They need ongoing stimulation to keep making the proteins and other parts they need to stay healthy and work well. In a stroke, nerve cells supplied by the blocked or burst blood vessel lose their supply of glucose and oxygen, and many are lost unless blood flow is restored quickly.
No one can bring back nerve cells that have been lost. But the lost cells usually aren’t the only reason for the symptoms after a stroke.
That’s where diaschisis comes in. Each nerve cell receives signals from thousands of other nerve cells, and that input helps keep it active and healthy. When nerve cells are lost in a stroke, other nerve cells they connected to, even in areas with a normal blood supply, can lose that input. Those cells may become less active, lose endurance and tire easily, even though they still get plenty of glucose and oxygen (8).
These weakened but still-living nerve cells need the right amount of activity. Too little activity can leave them underused, while too much can overwhelm them. But if we can find another pathway that feeds into these cells, and activate it at a level they can handle, it may help rebuild function in the affected areas.
This idea guides our approach to rehabilitation after a TIA or stroke. We use detailed testing to look not only at which areas are damaged, but also at which systems are still working but weakened. We look for pathways we can use to support those weakened systems, and we adjust how much and how often we stimulate them so they’re challenged without being overwhelmed. Then we choose therapies based on what your nervous system needs, with the goal of helping you recover as much function as possible.
Electrical stimulation. Gentle electrical stimulation of the nerves through the skin, called repetitive peripheral sensory stimulation, can stimulate the brain through the nerves of the body. It has been studied for improving movement after strokes and other blood vessel injuries in the brain (9).
Light therapy. Photobiomodulation uses low-level laser and LED light. It has been studied as a way to support nerve cell energy and function after a stroke and other blood vessel injuries (10, 11).
Transcranial magnetic stimulation. TMS uses magnetic pulses to stimulate specific areas of the brain. It has been studied for restoring movement and for chronic pain after a stroke (12, 13). TMS is generally safe and well tolerated. At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you.
Balance and vestibular therapy. Balance problems are very common after a stroke and raise the risk of falls, including head injuries. Reducing fall risk is a priority in our care. Vestibular therapy has been shown to help improve balance after a stroke (14).
Vision and eye movements. Vision is often affected after a stroke. People may have trouble mapping their surroundings and their body, keeping their eyes steady on a target, following moving objects or handling busy visual environments, and some lose part of their field of vision. We use visual exercises and rehabilitation tailored to your needs, an approach supported by research (15). Certain eye movement exercises have also been studied for supporting thinking and executive function (16), and one study found improvements in brain wave activity and symptom scores after stroke (17).
Constraint-induced movement therapy. Sometimes the best way to help a weak arm is to limit use of the stronger arm while doing intensive practice with the weaker one. This approach can help improve movement over time (18).
Mirror therapy. Mirror therapy uses a mirror image of your stronger limb to give your brain a different picture of the weaker limb during movement exercises (19). It has also been studied in a virtual reality environment (20), and we use our Virtualis system for this.
Spinal adjustments. Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (21, 22, 23, 24). One study in people with chronic stroke found that a single adjustment session increased the brain’s drive to a weakened leg muscle compared with a control, though it didn’t measure whether strength or walking improved (25), and joint manipulation has also been studied for movement after stroke (26). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just your spine. Chiropractic adjustments are used when appropriate and safe for you, along with physical exercise and soft tissue therapies.
Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions. The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward. We also review your risk factors for future events.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help you feel steady, clear and confident again, and to support you in protecting your brain going forward.
Your Next Step
A TIA can be a frightening wake-up call. It’s also an opportunity to take action. You don’t have to navigate what comes next alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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