McIntyre and Tablelands Stroke Service

(MATSS)

TIA
(Transient Ischemic Attack)
An Information Package for Patients, Carers and Families

Acknowledgements
This booklet has been developed by the Stroke Care Coordinator for the
McIntyre and Tablelands Stroke Service (MATSS) for use in all McIntyre and
Tablelands Health Services.
We would like to acknowledge the authors of the stroke information booklets from
North Coast Area Health Service (NCAHS), Hastings Macleay Stroke Service,
Northern Sydney Central Coast Area Health Service (NSCCAHS) including Royal
North Shore Hospital and Central Coast Stroke Service, Sydney South Western
Area Health Service, who kindly gave permission to modify their existing booklets
to suit the needs of the MATSS.
We would also like to acknowledge and reference information accessed through
the National Stroke Foundation.
A number of contributions were made by the Allied Health, Nursing and Medical
staff at Armidale Rural Referral Hospital in the development of this package and
we thank everyone for their valuable input and feedback.

Table of Contents
Acknowledgements

What is a TIA?

What are the signs of TIA?

What causes a TIA?

What should I do if I think I am having a TIA?

What medical tests do I need to have?

So Ive had a TIAwhat now?

Medications

Surgery

10

How can I help myself?

11

Risk factors

11

Preventing further TIAs

13

What is a stroke?

17

Effects of a stroke

18

Is there recovery from a stroke?

18

Facts about stroke

19

What increases your risk?

19

The FAST message

20

People/Organisations who can help

21

Individual TIA management plan

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What is a TIA?
A Transient Ischemic Attack (TIA) is often called a mini stroke.

Transient symptoms usually last for less than 24 hours.

Ischaemic failure of blood flow to part of the brain.
Attack sudden onset of symptoms, which vary from person to
person depending on which part of the brain is starved of blood.

The warning signs are very similar to those of a stroke, but they do
not last as long anything from a few minutes up to 24 hours. As with
a stroke, they are an indication that part of the brain is not getting
enough blood. Early identification of symptoms and early diagnosis
and treatment greatly reduces the risk of a major stroke occurring.
A TIA is considered the last warning sign before a major stroke
may occur.

What are the Signs of a TIA?

Sudden blurred or decreased vision in one or both eyes
Numbness, weakness or paralysis of the face, arm or leg
usually on one side of the body
Difficulty speaking or understanding speech
Dizziness, loss of balance or an unexplained fall
Difficulty swallowing
Severe headache or an unusual change in headache pattern
Unexplained nausea or vomiting
These warning signs should not be ignored. These signs are
exactly the same as the signs of a stroke, so you cannot tell if it
is a TIA or stroke and immediate emergency treatment should
be sought.

What Causes a TIA?

A TIA happens when blood going to the brain is suddenly interrupted
for a short period of time.
Blood is carried to the brain by blood vessels called arteries. The flow
of blood to the brain may stop moving because the artery may
become blocked by a clot or plaque. In some cases, a TIA may be
caused by the artery bursting or breaking causing a small bleed in the
brain.
When the blood flow to the brain is affected, the brain cannot get the
oxygen and food it needs and brain cells in the area start to die.
These cells usually die within minutes to a few hours after blood flow
stops. Once blood flow starts again, the brain gets the oxygen and
food it needs and the signs of a TIA may disappear.

What Should I Do if I Think Im Having a TIA?

A TIA should NEVER be ignored.
TIA is often a warning of impending stroke
Call 000 immediately
DO NOT wait to see if the symptoms resolve
If you, or someone you know, have any signs of a TIA, seek medical
attention immediately. Call 000. The sooner you seek help, the more
quickly you can receive the right medical attention and the doctor can
diagnose whether the symptoms are due to a TIA or not. DO NOT
WAIT to see if the symptoms resolve. Seek medical attention as soon
as possible, even if the symptoms seem to resolve quickly.

What Medical Tests Do I Need to Have?

The signs of a TIA are different for everyone. The doctor will want to
chat with you about the symptoms you experienced during your TIA.
They need to know how long they lasted for and whether they have
happened to you before.
The sorts of tests that you may need will depend on your past
medical history and what happened when you had your TIA. Tests
will vary from person to person but your doctor may ask for some or
all of the following tests to be carried out:
Blood pressure test
Blood tests to check clotting, and sugar and cholesterol levels
Electrocardiogram or ECG, which looks at the rhythms of the
heart
Chest x-ray to rule out any other medical problems
CT (Computerised Tomography) scan of the brain
Ultrasound of the arteries in your neck (carotid arteries) to
check the blood flow and look for any blockages that might
have caused the TIA
Ultrasound of the heart (called an echocardiogram) to check for
signs of heart disease

Blood Tests
A needle is inserted usually inside the elbow and blood collected into
tubes. After a TIA, the doctor needs blood samples to assess
cholesterol and other fats, blood glucose and other factors which may
lead to blood clotting (such as the thickness of the blood, sticky
proteins, missing proteins which protect you against clots, or
inflammations). If you need treatment for these sorts of problems, you
may need further blood tests to monitor the effectiveness of the
treatments e.g. Blood cholesterol or blood sugar.
High levels of cholesterol and triglycerides can be an indicator of
atherosclerosis (fatty deposits on the insides of blood vessels causing
narrowing of the vessels supplying the brain). High levels of blood
glucose can be characteristic of diabetes which is a risk for stroke.

ECG ( Electrocardiogram)
This test enables doctors to determine if the cause of
the stroke is related to the heart. An ECG examines the
heart rate, frequency and any other abnormality in the
heart beat.
Electrodes are placed on the patients chest, arms and
legs. An ECG monitor at the bedside in hospital uses
these leads and gives a continuous reading of the heart.
These leads remain on the patient while they are in the
emergency department. A similar monitoring system
may be used if you are transferred to the medical ward
for further care. This will be done using a Holter monitor,
which is a portable recorder worn at the waist.
There are no special precautions required by the patient
It is important for the patient to remain as still as possible while
an ECG recording with leads is made

CT (Computerised Tomography) Scan

This test can be used to study the brain. It is a painless test, where
the person having the scan lies on a CT scanner table with their head
inside the opening of the CT machine. The inside of the machine
rotates and takes X-rays of the head from different angles. The
scanner feeds this information into a computer and the computer then
makes pictures. An injection of a substance containing iodine may be
given. This is called a contrast medium and helps highlight areas in
the brain that are being examined.
This test is very useful as it enables doctors to determine if a
TIA/stroke has occurred and whether a bleed or a blockage caused
the event.
A person having a scan is asked to fast for two
hours before his or her appointment
It usually takes 20 minutes to an hour to
complete
There is no special care required after the test

Doppler Ultrasound Test

This test uses high frequency sound waves to detect blockages in
blood vessel walls. This test is often used to look for blood clots in the
legs and in the case of TIA/stroke, the blood vessels going to the
brain are investigated (in the neck region).
Ultrasound waves from a probe are able to travel through a blood
vessel and bounce off the blood cells within the vessel. Any change
in the sound waves gives important information about the blood flow
inside the vessel and lets the examiner know if a blood clot is present
or if the blood vessel is too narrow for normal blood flow.
This test takes about 20-40 minutes and the patient is required
to lie very still.
There is no special care required after the test.

Other common tests that may be done after a stroke:

Carotid Duplex: An ultrasound examination of the arteries in
the neck to look for narrowing which may have caused a lack of
blood flow and hence the TIA
Cardiac Echo: An ultrasound examination of the heart looking
at function, signs of irregular heartbeat or evidence of a clot that
could have been the cause of the TIA

Your Doctor will inform you of all of your test results once they are
known.

So Ive Had a TIA.What Now??

If your doctor confirms that you have had a TIA, the focus of your
care will be on preventing another TIA or even a stroke from
happening. It is important for you to have any medical tests done that
your doctor has recommended, and also make some changes to your
lifestyle. You may even need to take medication or for a small
number of people, have surgery.
Once you have had a TIA, your risk of having
another TIA or a stroke is increased.

Medications
Some people need to take medication following at TIA to help prevent
another TIA. This is usually medication that aims to lower cholesterol
and/or blood pressure and also lower the risk of clots forming in the
bloodstream that might block the arteries that carry blood to the brain.
Medication to lower cholesterol
Some people are prescribed medication to lower their cholesterol.
You can also lower your cholesterol by increasing the amount of
exercise that you do and eating a healthy diet. Talk to your GP or
local dietitian for more advice on how to do this.
Medication to lower blood pressure
It is common after TIA for people to be placed on medication to lower
their blood pressure. There are lots of different types that can be
prescribed so finding the right drug and the right dosage will be
important for your doctor to work out. It is important to see your
doctor regularly and let them know if you are having any problems
while taking your blood pressure medication in case they need to
prescribe something different.
Medication to stop the blood clotting
This is probably the most common medication that people are
prescribed following a TIA or stroke. This medication works to reduce
the risk of clots forming in the blood which may cause blockages in
the arteries affecting blood supply to the brain.

Platelets are the basic foundation of blood clots.

Medications such as Aspirin, work by stopping the
platelets from sticking together and forming blood
clots which can cause blockages in the arteries. It is
important that you only take Aspirin if prescribed by
your doctor.
There are other medication options such as dipryridamole or
clopidogrel again, your doctor will prescribe the medication which
best suits your needs. These drugs have the same effect as Aspirin
although they work a little differently.
Warfarin this medication is often prescribed to people who have
had a TIA or stroke due to a blood clot that has come from their heart.
The clot is usually the result of atrial fibrillation, or AF, where the
heart beats in an irregular way. Anyone taking warfarin needs to be
monitored closely by their doctor to make sure the dosage is correct
and that their blood does not become too thin.

Surgery following TIA

In some cases, people who have had a TIA may require a surgical
procedure called a carotid endarterectomy. This is needed if the
carotid arteries (the main arteries in your neck) become partially
blocked, affecting the blood flow to the brain. The surgery is usually
only beneficial in people who have a severe but not total blockage.
The aim of the surgery is to improve the blood flow to the brain and
reduce the risk of any clots breaking off and causing a blockage.
They do this by removing some of the lining of the artery that is
damaged and any other blockage within the artery. Some people may
require surgery on both their left and right carotid artery. If this is the
case, the surgery on each artery is usually carried out in separate
operations.
There is usually a good outcome after a carotid endarterectomy is
performed, however, there is also a small risk of stroke associated
with the procedure. It is important to discuss your medical situation
and the procedure carefully with your doctor before making any
decisions.
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How Can I Help Myself?

There are lots of things you can do to help lower your risk of further
TIA or stroke. It is important to be aware of the risk factors for these
conditions and do everything you can to avoid or lower your risk of
exposure to them.

Risk Factors
Most of the risk factors for TIA can be attributed to our lifestyle and
can be controlled by us.
Lifestyle-related risk factors include:

High blood pressure

Cigarette smoking
Poorly controlled diabetes
High cholesterol levels
Lack of regular exercise
Overconsumption of alcohol, such as frequent binge drinking
Obesity
High fat diet, particularly saturated fats
High salt diet, which can cause high blood pressure.
Oral contraceptive pill

It is important that you do everything you can to reduce these risk

factors. Speak with your GP, Stroke Coordinator or local Dietitian for
support and advice on how to successfully reduce your risk factors.

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Some of the risk factors for TIA and stroke are outside the individuals
control. These include:

Age (increasing)
Family history of stroke
Previous stroke / TIAs
Heart disease (or family history of heart disease)
Having diabetes (or family history of diabetes)
Gender (men are more likely than women to experience stroke)

Do you have any of the risk factors listed on this page?

If you have a known family history of stroke / TIA, heart or

vascular disease or diabetes it is important to have regular
medical checks with your GP to monitor:
Blood pressure
Blood glucose (sugar) level
Signs of early heart or vascular disease

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Preventing Further TIAs

Lifestyle risk factors for TIA & stroke can be CHANGED.

Blood Pressure - High blood pressure is the most common risk

factor for TIA / stroke. High blood pressure can result in damage to
the walls of the blood vessels eventually leading to TIA or
stroke. It is important to:

Know your blood pressure

Have regular checks by your doctor
Take medications (if prescribed)
Eat a healthy diet (low in salt) and exercise regularly

Smoking Smoking increases your risk of TIA/stroke by

increasing your blood pressure and reducing oxygen in the blood.
There is NO safe level of smoking, so it is important for you to quit as
soon as possible. For support in quitting smoking, speak to your GP
or cal the QUIT line on 13 18 48.

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Unmanaged Diabetes Diabetes can damage the entire circulatory

system and is a risk factor for stroke. Talk to your doctor about
controlling diabetes if you are diabetic. You should also make sure
you:
Monitor your blood glucose (sugar) level regularly
Take medications if prescribed
Eat a healthy diet and do regular physical activity

High Cholesterol A high cholesterol level is a contributing factor to

blood vessel disease, which often leads to TIA / stroke. Too much
cholesterol in the blood can cause a build up of fat in the walls of the
arteries resulting in narrowing or blockages of the arteries. It is
important to:
Know your cholesterol level have it checked regularly by
your GP
Eat a healthy diet:
o Diet low in animal fats, high in fruit and vegetables
o Choose vegetable oils and margarines
o Limit takeaway food and full fat dairy products.
o Eat lean meat
Take medication if prescribed

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Lack of Exercise - People who participate in moderate activity are

less likely to have a stroke. Try and build up to at least 30 minutes of
moderate physical activity most days of the week. Regular exercise
helps to reduce blood pressure, improve the level of fats in the blood
and assists in weight loss.

Excessive Alcohol Intake - Excessive amounts of alcohol

can raise blood pressure and increase your risk of stroke.
Moderate intake (1-2 glasses per day) can help to lower your
risk of stroke.

Obesity - Being overweight or obese can increase the risk of stroke.

Too much body fat can contribute to high blood pressure, high
cholesterol and can lead to heart disease and Type 2 diabetes. It is
important to:
Eat a healthy diet
Commence a moderate exercise program in consultation
with your doctor

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Oral contraception pill May be a risk factor for stroke in

conjunction with other risk factors. It may need to be changed to a
low dose version or ceased. Please check with your doctor.
High-risk groups
A stroke within three months of a TIA is more likely under certain
circumstances, including:

If the TIA lasts for longer than 10 minutes

If TIA symptoms include weakness and speech problems
If the person is older than 60 years
If the person has diabetes.

Dont IGNORE a TIA

TIAs SHOULD not be IGNORED as they are the MAJOR warning
sign for potential STROKE.

10% of people with TIA will have a stroke within 3 months.

STROKE can be PREVENTED by accessing help early and

minimising risk factors.

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What is a Stroke?
A stroke occurs when the blood supply to the brain is interrupted
suddenly, either by a blockage or by bleeding. The signs and
symptoms of stroke are the same as TIA but they do not resolve
within 24 hours.
Ischaemic Stroke
An ischaemic stroke happens when a
blood clot or particle blocks a blood vessel
or artery. When the blood supply to an area
of brain cells is lost, the cells begin dying
within minutes to hours. This affected area
is called an infarct. The cells die because
they no longer receive the oxygen and
nutrients they need to survive.

There are some cells surrounding the infarct that can still be saved.
By gaining quick access to treatment the damage to these cells can
be minimised. This means the potential damage after stroke can be
reduced.

Haemorrhagic Stroke
Bleeding into the brain, or haemorrhage, which is usually caused by
high blood pressure, can also cause stroke. This bleeding then puts
pressure on the brain cells so that they dont function as well.

When the brain cells die, the body loses the ability to carry out
the many functions of day-to-day living that we all take for
granted. This includes things like speech, movement and
memory.

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Effects of Stroke
Everything we do is controlled by different parts of the brain. When a
stroke occurs, we lose the ability to do things that the affected part of
the brain controls. We may not be able to move one side of the body
or have trouble thinking or speaking.
Stroke affects each person differently. The functions that may be
affected following a stroke include:
Physical - loss of power on one or both sides of the body,
difficulty sitting or standing independently
Sensory inability to feel touch, pain ,temperature or pressure
Visual loss of vision on one side, double vision
Speech speech may be slurred
Language difficulty in understanding and /or expressing
themselves
Thinking may be an impaired ability to think logically
Memory there may be loss of memory or persistent
forgetfulness
Emotional confused or mixed emotions occurring which may
be shown as crying inappropriately, frustration and anger and
some depression.
Swallowing difficulties swallowing food and fluids

Is There Recovery From a Stroke?

Recovery from stroke is dependent on many factors. The area of
brain affected will dictate the symptoms that you will have after a
stroke. The type of stroke will also have an impact on recovery as
does the time from onset of symptoms to when treatment is given.
Many people regain the same level of function as before their stroke,
while other people may not. Recovery from stroke is dependent on
many factors including which area of the brain is affected. Often the
level of recovery will not be known for several weeks to months. The
Physician and Rehabilitation Specialist will discuss your recovery with
you.

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Facts About Stroke

Second single biggest killer in Australia

Most common cause of permanent disability
Close to 60,000 strokes occurred in Australia last year
1 stroke occurs every 10 minutes
Stroke kills more women than breast cancer
Close to 20% of all strokes occur in people under 55 years old
1/3 of stroke patients do not survive
1/3 of stroke patients are dependent (to some extent) on others
for assistance with daily living activities
1/3 of stroke patients make a complete recovery
National Stroke Foundation, 2009

What Increases Your Risk?

The risk factors for stroke are exactly the same as those described
earlier for TIA.

High blood pressure

Cigarette smoking
Poorly controlled diabetes
High cholesterol levels
Lack of regular exercise
Overconsumption of alcohol, such as frequent binge drinking
Obesity
High fat diet, particularly saturated fats
High salt diet, which can cause high blood pressure.
Oral contraceptive pill
Age (increasing)
Family history of stroke
Previous stroke / TIAs
Heart disease (or family history of heart disease)
Having diabetes (or family history of diabetes)
Gender (men are more likely than women to experience stroke)

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Stroke Prevention
Proper diet and exercise
Reduce high blood pressure and cholesterol
Eliminate stress
View diabetes and heartbeat irregularities as high risk
End smoking habits
Never neglect stroke warning signs
Take your medication as prescribed

The FAST Message

Facial weakness - can the person smile? Has their mouth or eye
drooped?

Arm weakness - can the person raise both arms?

Speech difficulty - can the person speak clearly and understand

what you say?

Time to act fast - seek medical attention immediately

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REMEMBER:

TIA AND STROKE ARE A MEDICAL

EMERGENCY
CALL 000 IMMEDIATELY WHEN YOU
RECOGNISE THE SIGNS OF TIA OR
STROKE
People / Organisations Who Can Help
Stroke Care Coordinator
Armidale Rural Referral Hospital
Ph: 67769884
Contact your local GP
New England Division of General Practitioners
Phone: 6771 1146
Stroke Recovery Association
(02) 98076422 or 1300 650 594
www.strokensw.org.au
National Stroke Foundation
www.strokefoundation.com.au
Level 7, 461 Bourke Street
Melbourne VIC 3000
Phone +61 3 9670 1000
Fax +61 3 9670 9300
StrokeLine - 1800 787 653
StrokeConnect Online
www.strokefoundation.com.au/strokeconnect

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Individual TIA Management Plan

List any questions you may have for your doctor or any other health
professional.

The following recommendations have been made to reduce your risk

of stroke and TIA:
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