The symptoms of a transient ischemic attack are temporary and often resolve before the patient can be seen by a health care provider. Patient history is therefore of great importance. History from the family, witnesses, and emergency medical services, as well as the patient, should be obtained. History may include short-term alterations in :
Symptoms can vary from individual to individual and by the area of the brain affected. Frequently symptoms include  :
The symptoms are short-lived, usually lasting less than 15 to 60 minutes. Symptoms vary in severity.
Differential diagnoses to be excluded are   :
The initial workup for individuals presenting with a transient ischemic attack should be aimed at excluding other metabolic or drug-induced causes for the symptoms. Tests that should be done immediately :
A complete neurologic examination is a means of determining the area of neurovascular assault. The examination should include the following  :
Physical examination should include  :
Further testing may include  :
Imaging studies   :
Recommendations for evaluation and initial interventions for individuals presenting with transient ischemic attacks are   :
For cardio-embolic transient ischemic attacks long-term anticoagulation therapy is recommended using  :
Maintaining blood pressure below 140/90 mm Hg and total cholesterol below 200 mg/dL may prevent transient ischemic attacks, their recurrence or subsequent stroke .
Hospitalization may be required for early lytic therapy and other medical management and secondary prevention .
Hospitalization is required for  :
Angioplasty or stent placement to treat transient ischemic attacks are currently being investigated, but their usefulness is not yet known . Endarterectomy versus medical treatment alone has shown that surgery reduced the risk of stroke in patients with carotid stenosis, but the benefits were substantially less when surgery was delayed more than two weeks .
Recombinant human Interleukin-1ra (IL-1ra) administered intravenously has been shown to effectively reduce inflammation after a transient ischemic event. Though safe, its efficacy in the early hours after the ischemic episode are limited by its slow uptake. Further research is needed to find better therapeutic agents .
Transient ischemic attacks are episodes of temporary, focal cerebral dysfunction due to vascular occlusion and tissue ischemia  . Onset is acute and abrupt and the event is of short duration, from 15 minutes to 24 hours. Resolution of symptoms is rapid as well. Transient ischemic attacks leave no residual neurological deficit  . Differentials diagnoses include  migraine, epilepsy, syncope, or even neurosis.
Transient ischemic attacks are classified and initially evaluated using the ABCD (2) score . This evaluation tool is based on five criteria: Age > 60 years (1 point), blood pressure > 140/90 mm Hg (1 point), clinically unilateral weakness (2 points), speech impairment without weakness (1point), duration > 60 min (2 points) or 10 to 59 min (1 point) and diabetes (1 point) . The higher the score the higher the risk for recurrence of transient ischemia and/or eminent stroke  .
Patients are classified as follows  :
Transient ischemic attacks may also be classified as typical transient ischemia or nonspecific transient neurological attacks  . Typical transient ischemic attacks are the result of temporary vascular occlusion. Nonspecific transient neurological attacks may be due to cardiac abnormalities, such as arrhythmias . The non-specific form accounts for less than half of patients and studies have shown them to be at lower risk of subsequent stroke  .
The incidence of transient ischemic attacks is approximately 1 per 1000 population in the United States, accounting for 200,000-500,00 cases a year   . The reported incidence is lower in other developed countries  .
Approximately 15% of strokes occur in individuals with a history of previous transient ischemic attacks   . The incidence of transient ischemic attacks increases with age. The incidence is significantly higher in men than in women, approximately 1.5 to 1 .
The incidence in blacks is 1.5 times higher than that in whites  . This may, in part, be due to an increased prevalence of diabetes and cardiovascular disease in this population group .
Transient ischemic attacks are the result of a temporary decrease or cessation of cerebral blood flow to a portion of the brain  . They may be due to an acute thromboembolic event or chronic vascular stenosis. Cerebrovascular disease and atherosclerosis are the primary causes of the syndrome, and are a group of conditions that affect the blood vessels supplying the brain . Symptoms vary according to the area of the brain affected.
Other possible causes include  :
The pathophysiology of brain ischemia is related to the action of neuro-inflammatory mediators that increase the progression of tissue damage . With ischemia, increased levels of cytokines and chemokines cause the adhesion of white blood cells to the vascular endothelium . This process further impairs cerebral blood flow resulting in further damage and the increased risk of subsequent stroke.
Interleukin-1 (IL-1) is a group of cytokines that regulate the immune and inflammatory responses in the body. Recent research suggests that these substances may reduce brain injury by decreasing the inflammatory progression occurring post-ischemic episode .
After a transient ischemic attack, reducing stroke risk has an impact on subsequent morbidity and mortality. This will require extensive public education about the symptoms of these events and the importance of immediate evaluation, no matter the duration .
Transient ischemic attacks (TIA) are defined as temporary neurologic events that last less than 24 hours. They are due to short-term cerebral, spinal cord, or retinal ischemia   and not associated with tissue infarction and subsequent damage  . However, better imaging techniques have indicated that minimal tissue damage may occur in the shortest of episodes  .
Usual symptoms of transient ischemic attacks include hemiparesis, hemiparesthesia, dysphasia, diplopia and monocular blindness, imbalance and gait disturbances, and possible disorientation   .
The incidence of subsequent stroke in individuals who have had a transient ischemic attack may be as high as 10% within 3 months and 11 to 25% in the next 5 years   .
What is transient ischemic attack?
A transient ischemic attack refers to a temporary sudden decrease in blood supply to the brain resulting in short-term neurological symptoms. The cause of this disorder is a sudden decrease in blood supply to a part of the brain.
What are the symptoms?
The symptoms of transient ischemic attack include:
What causes transient ischemic attack?
Transient ischemic attacks are caused by interference with the blood supply to the brain. Reasons for this include:
Who gets transient ischemic attack?
Anyone who has cerebrovascular disease or disorders is at risk for transient ischemic attacks. The risk increases with age. The incidence is higher in men than in women and in blacks than in whites. Those at particular risk are individuals with high blood pressure, high cholesterol, diabetes, elevated body mass index (BMI), and atherosclerosis.
How is it diagnosed?
The symptoms of the disorder are of such short duration, often 1 to 60 minutes, that they may be gone before the individual can be seen by a healthcare provider. Transient ischemic attacks are diagnosed initially by the history of the event, symptoms, duration, and residual effects. Diagnosis is then a matter of excluding other possible diagnoses such as migraines, seizures, and hypoglycemia. Once it is determined that the symptoms are caused by a transient ischemic episode, the underlying cause of the decreased blood flow must be identified and that issued needs to be treated.
How is transient ischemic attack treated?
If it is determined that the transient ischemic attack is due to an embolism or clotting problem medications to decrease the formation of clots can be effective. These medications include warfarin (Coumadin) or heparin in the acute phase, and/ aspirin.
If the underlying cause is occlusion due to embolus or stenosis (clot or narrowing of blood vessel) surgical intervention may be needed. New medications are currently being researched for use in transient ischemic events. These medication reduce the inflammation caused by brain ischemia and may help to prevent subsequent strokes.
What are the complications of transient ischemic attack?
The main complication of transient ischemic attacks is cerebral vascular accidents or stroke. Research has shown that 15-25% of people who experience a transient ischemic attack will experience a stroke within 3 months to 5 years. Strokes result in permanent disability or death.
How can transient ischemic attacks be prevented?
After a transient ischemic attack, reducing stroke risk has an impact on subsequent morbidity and mortality. Maintaining blood pressure below 140/90 mm Hg and total cholesterol below 200 mg/dL, weight loss and maintenance of normal body mass index may help to preventive transient ischemic attacks and stroke.