Transient Ischaemic Attack (TIA)

The most common signs of a TIA can be remembered with FAST:

• Face: One side of the face may droop, or the person may struggle to smile.
• Arms: Weakness or numbness in one arm; difficulty lifting both arms up to shoulder level and holding for approx. 10 sec.
• Speech: Slurred, garbled, or difficult to understand; trouble understanding others.
• Time: If you observe any of these signs, call emergency services immediately — even if symptoms go away. (This is standard stroke-recognition advice.) ²

Other possible symptoms include: sudden loss of vision (in one or both eyes), double vision, dizziness or loss of balance, difficulty swallowing, or coordination problems.³

A TIA most often results from a tiny clot or debris (embolic material) that temporarily blocks a blood vessel in the brain. These clots break off from larger clots that may have formed

• in the heart⁴ or
• atherosclerotic plaques occurring in the large neck vessels (carotid arteries).

If the clot is larger, it does not break down quick enough to restore circulation to the brain, and this can cause a stroke.

Risk factors for clots in the heart include previous heart attack or atrial fibrillation (irregular heartbeat) where the blood does not flow freely through the heart and can stagnate, causing clots.

Risk factors for forming atherosclerotic plaques (build up of fatty deposits on the walls of the blood vessels)

• High blood pressure (hypertension) — the single biggest modifiable risk factor in South Africa.⁴
• High cholesterol, diabetes, obesity, smoking, and excessive alcohol use.¹
• Age (risk increases as you get older)
• Previous TIA or stroke.

• Treat any sudden neurological symptoms (face droop, arm weakness, speech trouble) as an emergency — call for an ambulance right away. Because you cannot tell at the onset if the neurological symptoms are due to a TIA (and will resolve) or a full stroke immediate medical evaluation is critical.
• Even if symptoms resolve, go to hospital for assessment. Early evaluation is key to preventing a future stroke. ¹
• Ask your doctor for a referral to a stroke unit / specialist or TIA clinic — ideally within 24 hours. South African stroke guidelines recommend early supportive care to prevent complications and rapid assessment and imaging as to the cause of the neurological deficit. ⁵
• Find out where your nearest stroke unit is and keep their contact details with your emergency numbers, especially if you have risk factors for a TIA/stroke

Because you cannot tell whether symptoms come from a TIA or a full stroke just by how they feel, immediate medical evaluation is critical. In South Africa, guidelines recommend rapid referral and assessment. ⁵

Doctors may perform:

• A physical and neurological exam
• Imaging of the brain (CT or MRI) to rule out stroke or other causes of the neurological deficit⁵
• Heart tests (such as an ECG and cardiac ultrasound) to check for atrial fibrillation or clots ²
• Blood tests, including cholesterol and clotting profiles
• Carotid imaging (e.g., ultrasound) to see if there is narrowing in the major arteries supplying the brain ⁵

After a TIA, the goal is to prevent a full stroke. Treatment depends on what caused your TIA, but may include:

Medicines

• Antiplatelet drugs: Aspirin is most common. In some cases, aspirin is combined with clopidogrel, especially in the early period after a TIA.²
• Anticoagulants: If you have atrial fibrillation, your doctor may prescribe a direct oral anticoagulant (e.g., apixaban, rivaroxaban) to prevent clot formation.²

Surgery or Procedures

• Carotid endarterectomy: If there is severe narrowing (70–99%) of the carotid artery, surgery to remove plaque may be recommended — ideally soon after the TIA, in experienced centres.⁵
• Angioplasty and stenting: In some cases, a procedure to open the artery and insert a stent may be considered. ²

Ongoing Monitoring & Support

• Regular follow-up to manage existing risk factors pressure, cholesterol, and heart rhythm
• Secondary prevention of other risk factors.⁵

Because TIA is a major warning sign, reducing risk factors is essential. Preventive measures include lifestyle changes and medical management:

1. Manage high blood pressure — This is most critical.⁴
2. Eat a healthy diet — Include fruits, vegetables, whole grains; limit salt, saturated fat, cholesterol, and sugar.³
3. Be active — Regular physical activity helps control weight, blood pressure, and cholesterol.³
4. Quit smoking — Smoking greatly increases stroke risk.³
5. Limit alcohol — Reduce drinking to moderate levels or less.³
6. Manage other health conditions — Control diabetes, cholesterol, and heart rhythm (e.g., atrial fibrillation) with the help of your doctor. ⁵

As there are multiple risk factors for developing a TIA, a multidisciplinary approach by specialists and disciplines may be required as per the South African stroke-care guidelines

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.