Brain (CNS)
Transient Ischemic Attack
일과성허혈발작
Transient neurologic deficit resolving within 24 h (usually <1 h) without infarct
- How common
- ~500,000/yr (US)
- Typical age
- 60+
What is it?
Transient occlusion → brief ischemia → spontaneous reperfusion → no permanent infarct (clinical definition without DWI lesion).
Commonly affected: Carotid or vertebrobasilar territory
How it develops
- Brief occlusionMicroembolus or hemodynamic hypoperfusion
- Transient ischemiaBrief neurologic deficit
- Spontaneous reperfusionClot lysis or collateral flow
- Stroke warning10-20% stroke risk within 90 days
Symptoms
- Transient hemiparesisResolves <1 h
- Amaurosis fugaxTransient monocular blindness
- Transient aphasiaWord-finding difficulty
- Vertigo/diplopiaPosterior circulation TIA
How it is examined
- ABCD2 scoreAge, BP, Clinical, Duration, DM (0-7)
- Carotid auscultationBruit suggests stenosis
- ECG/echoAssess AFib/cardiac source
Imaging
Head CT to rule out bleed; MRI DWI for small infarct.
- Normal CT
- Normal DWI (defines TIA)
Carotid Doppler or CTA/MRA for stenosis assessment.
- Carotid stenosis degree
- Large vessel evaluation
Non-surgical care
- DAPTAspirin + clopidogrel x 21 days (CHANCE/POINT)
- High-intensity statinAtorvastatin 80 mg/day
- BP/glycemic controlBP <130/80, HbA1c <7
- Anticoagulation for AFibDOAC per CHA2DS2-VASc
- Smoking cessation/lifestyleCornerstone of prevention
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Symptomatic carotid stenosis 50-99%
Procedures that may be discussed
- Carotid endarterectomy (CEA, within 2 weeks)
- Carotid artery stenting (CAS)
- LAA occlusion for AFib
Outlook
Untreated 90-day stroke risk 10-20%; rapid evaluation/treatment reduces by 80%.