Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany. He is presently working in Columbia asia hospitals, Bangalore. His main areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endovascular Neurosurgery, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.He has advanced training in both Brain Aneurysm coiling and clipping, Brain AVM embolizations and its surgical removal, carotid artery stenting and carotid endarterectomy. Since he is trained both in open microvascular Neurosurgery and in Interventional Neurosurgery he helps patients in choosing the right treatment options for brain vascular diseases with out any bias of one treatment over the other.

1. Don’t ignore Transient
Ischemic Attack
(TIA)-Mini Stroke
Dr. Avinash KM
MS, MRCS Ed(UK), Mch (KEM, Mumbai), FINR(Switzerland), FMINS(Germany),
• Interventional & Neurovascular surgeon and Stroke specialist,
• Endoscopic Neuro and Spine surgeon,
• Minimally invasive Neuro and Spine surgeon (FMINS).
mob: 9740866228, E mail: doc_avin@hotmail.com
Consultant Neurosurgeon and Neurointerventionist
Columbia Asia Hospital, Bangalore.

2. What is TIA?
A transient ischemic attack (also called TIA or "mini-
stroke") is one of the most important warning signs of
a stroke.
A TIA occurs when a blood supply to the brain is
momentarily blocked by a blood clot/ or reduced flow
due to block in blood vessels, which supply blood to
brain.
The symptoms of a TIA, which are temporary and may
last a few seconds to minutes.
A TIA is a medical emergency, since it is impossible to
predict if it will progress into a major stroke. If you or
someone you know experiences these symptoms, get
emergency help .
Immediate treatment can save your life or increase your
chance of a full recovery.

3. What are the causes of TIA?

4. What are the risk factors for TIA?

5. How to assess risk of TIA/ Stroke?
Assess yourself. Depending on risk group in which you fall, treatment can be offered

6. Are you at risk?
If you have more than 3 risk factors in the high risk block (red
coloured column) then u should consult stroke specialist.
If you have 4 to 6 factors in yellow column then you should work
on some of life change modifications.

7. What are the clinical features?
These symptoms shown in diagram are transient lasting for few seconds to few
minutes. Many of us don’t give attention to these symptoms. Getting Transient
giddiness, visual blockout, headache is common to everyone. It doesnot mean
everyone has to rush to the hospital. People who have risk factors who develop
these symptoms should have a immediate check up. Risk group who need
check up - Next slide

8. Who should visit if they have TIA
symptoms?
Following are the people who should be ALERT if they develop these
symptoms
• Family history of atherosclerosis (either carotid artery disease or coronary
artery disease or elsewhere in the vascular system)
• Age: Over 55 years of age
• High levels of cholesterol in blood test.
• Smoking
• High blood pressure (hypertension)
• Diabetes
• Obesity
• Sedentary lifestyle
Some times people have TIA and fall & have head injury and come for head
injury. Its important to have detailed history and the circumstances of fall.

9. Why treating TIA is important?
TIA can precede stroke, with short-term stroke
risk being particularly high, exceeding 10% in
90 days and studies confirm the elevation of
that risk into the long term.
The timing of a TIA before stroke is highly time
dependent, with studies showing 17% occurring
on the day of the stroke, 9% within the previous
day, and another 43% within the previous
week. So identification of TIA is important and
urgent evaluation of TIA and immediate
initiation of treatment reduces stroke risk.

10. How to investigate TIA?
• Detailed history
• Blood investigations - Lipid profile
- coagulation profile
- for diabetes
• ECG
• Echo in some patients.
• Carotid and vertebral Doppler study.
• MR angiogram in selected patients specially in Asian
subcontinent where chance of intracranial vascular occlusion is
high.
• CT angiogram if MRA not available.

11. What are the treatments available
for TIA?
Your treatment for a TIA may include taking medicines to prevent
a stroke or having surgery to reopen narrow arteries.
Medicines may include Aspirin, clopidogrel, dipyridamole, with
aspirin, or warfarin
If your carotid arteries/ intracranial arteries are significantly
blocked, you may need surgery/ endovascular treatment to
reopen the narrowed arteries.
If cardiac conditions are the cause, may need appropriate
treatment.

12. Prevention of TIA or stroke:
The most important thing to do is BE HEALTHY. Most of the
things on the following list follow common sense:
• Don’t smoke
• Keep your blood pressure under control
• Keep your cholesterol within a normal range
• Eat a well balanced diet with foods high in fiber and low in
saturated (animal) fats, as well as a lot of fruits and vegetables
• Maintain a healthy weight
• Do not drink more than in moderation if you choose to drink
• Exercise regularly
• Don’t do illegal drugs
• Keep stress levels under control

13. TIAs are strong predictors of future
strokes; a person who has experienced
a TIA is 10 times more likely to suffer a
major stroke than someone who has
not experienced a TIA.