Transient Ischemic Attack (TIA)

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What is a transient ischemic attack (TIA)?

Some people call a transient ischemic attack (TIA) a mini-stroke, because the symptoms are like those of a stroke but do not last long. A TIA happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage.

A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 . Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.

What are the symptoms of a TIA?

Symptoms of a TIA come on suddenly.

• One side of your body may feel numb, tingly, or heavy.
• You may not be able to move your arm, your leg, or your face on one side of your body.
• Things may look blurry or dim. You may have double vision or not be able to see.
• It may be hard to speak or understand words.
• You may feel unsteady, dizzy, or clumsy.

What causes a transient ischemic attack?

A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. Once the clot dissolves, blood flow returns, and the symptoms go away.

Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a "low-flow" TIA. It is not as common as other types.

See a picture of a transient ischemic attack .

What tests do I need after a TIA?

Your doctor will do tests to look at your heart and blood vessels. You may need:

• Tests that show pictures of your brain and blood vessels, such as a CT scan, an MRI, a magnetic resonance angiogram (MRA), or an angiogram.
• A test that uses sound to check your blood flow (Doppler ultrasound).
• An echocardiogram (echo) to check your heart's shape and its blood flow.
• An electrocardiogram (EKG) to measure your heart rhythm.

Your doctor will also check to see if something else is causing your symptoms.

How is it treated?

Your doctor will start you on medicines to help prevent a stroke. You may need to take several medicines.

If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may need surgery to open them up (carotid endarterectomy). This can help prevent blood clots that block blood flow to your brain. Another type of surgery is carotid artery stenting. During this surgery, the doctor puts a small tube called a stent inside your carotid artery. This helps keep the artery open.

You can do a lot to reduce your chance of having another TIA or a stroke. Medicines can help, but you may need to make lifestyle changes too.

• Keep your blood pressure and cholesterol under control.
• If you have diabetes, keep your blood sugar in your target range.
• Take your medicines just as your doctor says to.
• Eat healthy foods that are low in saturated fat and cholesterol.
• Get some exercise on most, preferably all, days of the week.
• If you smoke, quit. Avoid secondhand smoke too.
• Avoid getting sick from the flu. Get a flu shot every year.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I have carotid endarterectomy for stroke or transient ischemic attack (TIA)?
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	Stroke risk from atrial fibrillation

Blood clots that temporarily block blood flow to the brain are the most common cause of transient ischemic attacks (TIAs). Blood clots may develop for a variety of reasons.

• A blood clot can form in an artery that supplies blood to the brain.
  • Blood clots usually form in arteries damaged by plaque buildup, which is a process called atherosclerosis.
  • Long-standing high blood pressure or diabetes may damage smaller blood vessels in the brain, causing a clot to form within the blood vessels and block blood flow.
• A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to an artery that supplies blood to the brain. For example, clots may form:
  • After a heart attack.
  • As a result of other conditions that alter how blood flows through the heart, such as abnormal heart rhythms (especially atrial fibrillation), heart valve problems or heart failure.

In addition, an artery that is partially blocked with plaque can reduce blood flow to the brain and cause symptoms.

Rare causes of blood clots that can cause a TIA include:

• Clumps of bacteria, tumor cells, or air bubbles that move through the bloodstream.
• Conditions that cause blood cells to stick together. For example, having too many red blood cells (polycythemia) or having abnormally shaped red blood cells, such as those caused by sickle cell disease, may cause blood clots to form.
• Inflammation in the blood vessels, which may develop from conditions such as syphilis, tuberculosis, or other inflammatory diseases.
• A head or neck injury that results in damage to blood vessels in the head or neck.

Symptoms of transient ischemic attacks (TIAs) develop suddenly and are always temporary. They usually go away within 10 to 20 minutes. TIA symptoms are just like stroke symptoms. They vary depending on which part of the brain is affected. Common symptoms of TIA include:

• Weakness on one side of your body or an inability to move a part or all of one side of your body, such as your face, arm, and leg.
• Numbness, tingling, or a feeling of heaviness on one side of your body.
• Loss of vision or changes such as blurring or double vision, dimness, or a sensation that a shade has been pulled down over the eyes.
• Difficulty speaking or finding or understanding words.
• Vertigo, unsteadiness, dizziness, clumsiness, staggering, or fainting. You may also have a drop attack, which is a sudden loss of strength in your legs.

It is not always easy to recognize a transient ischemic attack (TIA) because you may think that the symptoms are caused by normal aging or other conditions. But you should treat any symptoms of a TIA as an emergency because you have no way to know whether they are from a stroke or a TIA.

Symptoms of a transient ischemic attack (TIA) usually go away within 10 to 20 minutes, but some can last up to 24 hours. If symptoms last longer than an hour, it is more likely that you have had a stroke.

TIA symptoms, which are caused by a blood clot that temporarily reduces blood flow to the brain, disappear when the blood clot dissolves and blood flow returns.

A TIA is a warning sign that a stroke may soon follow. Any symptoms of a TIA need to be treated as an emergency.

• Of those who survive a first TIA or stroke, 14% will have another TIA or stroke within 1 year.¹
• A cluster of TIAs that increase in frequency, become more severe, or last longer is a sign that a stroke may soon occur.

A TIA also may signal an increased risk for a heart attack. Atherosclerosis, which is hardening of the arteries, affects blood vessels throughout the body, including arteries that supply blood to the heart and brain. Atherosclerosis that affects the blood vessels in the heart (coronary arteries) may cause chest pain or a heart attack.

The risk factors for a transient ischemic attack (TIA) are the same as those for a stroke.

Risk factors you can change

Risk factors for TIA that you can change are:

• High blood pressure.
• Smoking and regular exposure to secondhand smoke , which are strong risk factors for stroke, TIA, and heart attack.²
• High cholesterol.
• High triglycerides.³
• Excessive use of alcohol.
• Use of birth control pills, especially in women who smoke or have a history of blood clots.
• Lack of exercise.
• Use of cocaine.

Risk factors you cannot change

Risk factors for TIA that you cannot change are:

• Age: Most TIAs happen after the age of 60.
• Family history: People with a family history of TIA or stroke are at higher risk.
• Prior history of TIA: People who have had a TIA are more likely to have another TIA or a stroke.

Diseases that increase the risk for TIA

Your risk for TIA increases if you have diseases such as:

• High blood pressure.
• Diabetes.
• Hardening of the arteries (atherosclerosis), especially of the carotid arteries.
• Atrial fibrillation and certain other heart conditions, such as coronary artery disease, heart failure, or heart valve disorders.
• Conditions that cause blood cells to stick together and form clots, such as having too many red blood cells (polycythemia) or having abnormally shaped red blood cells, such as those caused by sickle cell disease.

In a recent small study, researchers suggested a possible link between gum disease and thickened carotid arteries. Although more study is needed, some researchers believe that infections may trigger inflammation in the blood vessels, which can lead to hardening of the arteries (atherosclerosis) and an increased risk for TIA and stroke.⁴

Call 911 or other emergency services immediately if you have:

• Sudden numbness, tingling, or weakness in or an inability to move part or all of one side of your body, such as your face, arm, and leg.
• Brief vision changes that come on suddenly, such as dimness, blurring, double vision, or loss of vision in one or both eyes (usually described as a feeling that a shade is being pulled down over your eyes).
• Sudden difficulty speaking or understanding speech.
• Sudden dizziness, clumsiness, staggering, a drop attack, or fainting (loss of consciousness).
• Sudden, severe headache that is different from previous headaches and is without a known cause.

Call your doctor immediately if you have:

• Recently had symptoms of a transient ischemic attack (TIA), and the symptoms have completely disappeared.
• Had a TIA or stroke while taking aspirin or other medicine that prevents blood clots, and you notice any signs of bleeding.

Call your doctor today if you think you have had a TIA in the past and have not yet talked with your doctor about your symptoms.

Watchful Waiting

Taking a wait-and-see approach, called watchful waiting, is not appropriate if you are having symptoms of a TIA. Any symptoms of a TIA need to be considered a medical emergency. Seek medical assistance immediately.

Who To See

The following doctors can diagnose and treat a transient ischemic attack (TIA):

• Family medicine doctor
• Neurologist
• Emergency medicine specialist
• Internist

Other specialist(s) may be consulted if you need surgery or have other health problems:

• Neurosurgeon
• Cardiologist
• Vascular surgeon (one who specializes in surgery of the blood vessels)

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Immediate evaluation is recommended if you have had or are having a transient ischemic attack (TIA). The purpose of evaluation is to:

• Check for another cause of your symptoms, such as a stroke, low blood sugar (if you have diabetes), or Bell's palsy.
• Look for a blood clot.
• Determine whether you need surgery to reopen a blocked artery (carotid endarterectomy).
• Determine whether you need medicines to prevent blood clots.

If your TIA symptoms have completely disappeared, the results of a physical exam will be normal, and the diagnosis of a TIA usually will be based on your medical history and certain tests.

If a TIA is suspected, the doctor may want to do tests, such as a:

• CT scan of the head to check for bleeding in the brain when symptoms of a TIA are occurring and to check for evidence of a stroke or other disease, such as a tumor.
• MRI scan.

Further tests are often done to identify the underlying cause of the TIA. If blockage of the carotid arteries is suspected, you may have tests such as:

• A Doppler ultrasound.
• A magnetic resonance angiogram (MRA). See an illustration of a TIA angiogram .
• An angiogram of your head and neck.

TIA symptoms may be due to blood clots caused by a heart problem. If heart problems are suspected, you may have tests such as a:

• Chest X-ray to assess the size and shape of your heart.
• Electrocardiogram (ECG, EKG) or Holter monitoring or ambulatory EKG to assess heart rhythm.
• Echocardiogram (echo) to examine the shape of the heart chambers and blood flow through them.
• Cholesterol and triglycerides tests to check the level of these blood fats that can increase your risk for blood clots and hardening of the arteries.

If you have had a transient ischemic attack (TIA), you will probably need to take a medicine to help prevent blood clots. If the carotid arteries in your neck are significantly blocked, you may also need to have surgery to reopen the narrowed arteries. In addition, if you have high blood pressure, diabetes, or high cholesterol, you will also need treatment for those diseases.

Initial treatment

If you have symptoms of a transient ischemic attack (TIA), seek medical help immediately. If your symptoms have gone away, contact your doctor as soon as possible. A TIA is a sign that a stroke may soon follow, and prompt medical treatment may prevent a stroke. About 14% of people who survive a first TIA or stroke will have another TIA or a stroke within a year.¹

You will need to take medicine that will reduce the risk of future blood clots. These medicines may include aspirin, clopidogrel, dipyridamole with aspirin, or warfarin.

If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). Endarterectomy surgery also may be appropriate for some people who have not had a TIA but who have significant narrowing in an artery.

Another option to reopen narrowed carotid arteries is angioplasty with stenting. This procedure is much like the one used to open up clogged heart arteries. A doctor threads a thin tube called a catheter through an artery and up to the carotid arteries in your neck, and then he or she inflates a tiny balloon to enlarge the narrowed artery. The doctor places a wire mesh device called a stent in the artery to keep it open.

Should I have carotid endarterectomy surgery for TIA?

Ongoing treatment

Ongoing treatment will focus on preventing another transient ischemic attack (TIA) or stroke and reducing additional risk factors for stroke. This may include:

• Reducing high blood pressure, the most common risk factor for stroke, by making changes to your diet and taking blood pressure–lowering medicines.
• Taking aspirin or another antiplatelet medicine to prevent strokes. It has been shown that people who have had a stroke, a TIA, or an endarterectomy may benefit from taking aspirin or another antiplatelet medicine, such as aspirin with extended-release dipyridamole, daily to prevent another stroke.
• Taking anticoagulant medicines, which are commonly called blood thinners, if you have atrial fibrillation. People with atrial fibrillation who have had a TIA usually need to take anticoagulants, such as warfarin (Coumadin, for example) to reduce their risk of stroke. Recent studies show that anticoagulants are better than antiplatelet medicines (like aspirin) at preventing strokes for this group of people.⁵ Some people cannot take anticoagulants, however. In this case, you will probably be given another medicine to reduce your chance of having a stroke.
• Taking statins to lower high cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.⁶
• Controlling diabetes. Your doctor will advise that you try to keep your blood sugar levels at normal or near-normal levels. To do this you may need to take oral medicines or insulin. Eating a healthy diet and getting plenty of exercise will also help.
• Avoid getting sick from the flu. Get a flu shot every year.

You may also need to make lifestyle changes such as:

• Quitting smoking and avoiding secondhand smoke.. People who smoke have a higher risk of stroke than those who quit. Stop-smoking programs, medicines, and counseling can boost your chances of quitting for good.
• Maintaining a healthy weight. Being overweight increases your risk of developing high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
• Eating a well-balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods may make hardening of the arteries worse. Increase fruits and vegetables in your diet to increase potassium and vitamins B, C, E, and riboflavin.
• Getting regular exercise. Physical activity significantly lowers your risk of stroke. Walking is a simple way to start getting exercise. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
• Keeping alcohol consumption low to moderate (from 1 drink per week to less than 2 drinks per day), which may decrease the risk of stroke caused by a blockage (ischemic stroke).⁷ Excessive use of alcohol increases your risk of stroke.

Watch for signs of bleeding. Call your doctor if you are taking aspirin or other medicines that slow blood clotting (such as warfarin, ticlopidine, clopidogrel, or aspirin with extended-release dipyridamole) and you notice unusual bruising or bleeding. Follow these safety tips when taking medicines that slow blood clotting.

Treatment if the condition gets worse

If you have more than one transient ischemic attack (TIA) close together (a cluster of TIAs), you may be hospitalized because of the increased risk for stroke.

Emergency treatment for stroke is most effective if done within the first 3 hours after symptoms begin.

For more information, see the topic Stroke.

What To Think About

After you have an initial evaluation for a TIA, you may need further testing and treatment on an outpatient basis. However, because of the increased risk of stroke, staying in the hospital may be recommended for:

• People who have had more than one TIA close together (a cluster of TIAs).
• People who have had TIAs because of a heart condition, such as atrial fibrillation.
• Those who have symptoms which indicate that a large area of the brain is affected.
• Those whose symptoms last longer than an hour.
• Older adults and those with significant risk factors for stroke, such as diabetes and heart disease.

You can help prevent a transient ischemic attack (TIA) by controlling your risk factors for stroke.

• Have regular medical checkups. Work with your doctor to control high blood pressure, high cholesterol, heart disease (especially atrial fibrillation), diabetes, and disorders that affect blood vessels and how your blood clots, such as polycythemia and sickle cell anemia.
• Quit smoking. Daily cigarette smoking can increase the risk of stroke by 2½ times.⁸ Regular exposure to secondhand smoke also increases your risk of stroke.²
• Check with your doctor about whether you should take an aspirin each day and medicine to lower your cholesterol, if you have been told that you have hardening of the arteries (atherosclerosis). It has been shown that for people who have had a stroke, a TIA, or an endarterectomy, taking aspirin or other antiplatelet medicines, such as aspirin with extended-release dipyridamole, daily may help prevent another stroke.
• Ask your doctor about taking cholesterol-lowering medicines called statins if you have high cholesterol or have had a heart attack.⁹
• If you have had a prior TIA, taking blood pressure–lowering medicines may help prevent another TIA or stroke.¹⁰
• Maintain a healthy weight. Being overweight increases your risk for high blood pressure, heart problems, and diabetes, which are risk factors for TIA and stroke.
• Eat a well-balanced diet that is low in cholesterol, saturated fats, and salt. Fatty foods may make hardening of the arteries worse. Eat more fruits and vegetables to increase potassium and vitamins B, C, E, and riboflavin.
• Get regular exercise, and reduce your stress. Try to do activities that raise your heart rate for at least 30 minutes on most, preferably all, days of the week.
• Keep alcohol consumption low to moderate (from 1 drink per week to less than 2 drinks per day), which may decrease the risk of stroke caused by a blockage (ischemic stroke).⁷ Excessive use of alcohol increases the risk of stroke.
• Avoid taking birth control pills (oral contraceptives) if you have other risk factors for TIA or stroke, such as smoking, high cholesterol, or a history of blood clots. Talk to your doctor about other forms of birth control that do not increase your risk of TIA and stroke.
• Avoid getting sick from the flu. Get a flu shot every year.

Because atrial fibrillation increases your risk of stroke and because many people do not have symptoms of atrial fibrillation, the National Stroke Association recommends that everyone, particularly those age 55 or older, check his or her heartbeat once a month. To learn how to check your pulse, see taking your pulse . If you notice that your heartbeat does not have a regular rhythm, talk to your doctor.

If you have atrial fibrillation, use this tool to check your risk of stroke: Interactive Tool: Stroke risk from atrial fibrillation .

Home treatment is not appropriate for a transient ischemic attack (TIA). If you think you are having a TIA, do not ignore the symptoms and do not try to manage them at home. Seek emergency medical care when symptoms first appear. Prompt treatment may keep you from having a stroke.

If you have had a TIA recently:

• Follow your treatment plan to help prevent another TIA or stroke.
• Call your doctor if you are taking aspirin or other medicines that slow blood clotting (such as warfarin, ticlopidine, clopidogrel, or aspirin with extended-release dipyridamole) and you notice unusual bruising or bleeding. Follow these safety tips when taking medicines that slow blood clotting, and be alert for signs of bleeding.
• Work with your doctor to control any medical conditions that may increase your risk of having another TIA or stroke, such as high blood pressure, atrial fibrillation, high cholesterol, or diabetes.
• Eat a healthy, balanced diet.
• Do not smoke. (For more information on how to quit, see the topic Quitting Tobacco Use.) Avoid secondhand smoke too.
• Get regular exercise.
• Avoid excessive use of alcohol.
• Avoid getting sick from the flu. Get a flu shot every year.

Your doctor will probably prescribe several medicines after you have had a transient ischemic attack (TIA). Medicines to prevent blood clots are typically used since blood clots can cause TIAs and strokes. There are two different types of medicines that prevent clotting: antiplatelet medicines and anticoagulant medicines.

Cholesterol-lowering and blood pressure-lowering medicines are also used to prevent TIAs and strokes.

Antiplatelet medicines

Antiplatelets (such as aspirin, aspirin with extended-release dipyridamole, or clopidogrel) keep platelets in the blood from sticking together.

• Aspirin is most often used to prevent TIAs and strokes. Many studies have shown that aspirin helps prevent strokes and reduces the risk of another TIA in people who have had their first TIA.
• Other antiplatelet medicines (such as clopidogrel) may be used for people who cannot take aspirin or for whom aspirin has not been effective.
• Aggrenox, a medicine that combines aspirin with dipyridamole, is a safe and effective alternative to aspirin to prevent TIA and stroke for some people.¹¹ However, people with chronic stable angina cannot take dipyridamole.

Anticoagulants

Anticoagulants prevent the production of certain proteins that are needed for blood to clot. If you have atrial fibrillation, you will probably take an anticoagulant (such as warfarin). Anticoagulants are more effective than antiplatelets in preventing strokes in people with atrial fibrillation.⁵

Both anticoagulants and antiplatelets increase the risk of bleeding. Warfarin (such as Coumadin) has the highest risk of bleeding problems, but the risk is lower when the dosage is closely monitored.

Cholesterol-lowering medicines

Experts recommend that most people who have had a TIA take statins, which lower cholesterol. Many studies show that statins significantly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.⁶ For more information on these medicines, see the topic High Cholesterol.

If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgical procedure, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed because the surgery itself may cause a stroke.

Should I have carotid endarterectomy surgery for TIA?

Carotid endarterectomy is appropriate if your carotid arteries are significantly blocked (50% to 70% or more) and you have had one or more TIAs. Guidelines suggest that some people who have less blockage and no previous TIA or stroke and who are at low risk of surgical complications may also benefit from carotid endarterectomy.¹² However, surgery is still considered controversial for people with less than 60% blockage and no symptoms of TIAs.

A relatively new procedure called carotid artery stenting is another option for some people who are at high risk of stroke. This procedure is much like coronary angioplasty, which is commonly used to open blocked arteries in the heart. During this procedure, a vascular surgeon inserts a metal tube called a stent inside your carotid artery to increase blood flow in areas blocked by plaque. The surgeon may use a stent that is coated with medicine to help prevent future blockage.

Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.

Surgery Choices

Carotid endarterectomy

What To Think About

Carotid endarterectomies are most successful when they are done by a surgeon who is well trained in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure.

If you are considering carotid endarterectomy, ask the hospital or state medical board about the number of times complications have occurred in people that your doctor has treated with this surgery and the complication rate at the hospital where the surgery is to be done. The American Heart Association Stroke Council recommends that surgery be performed by a surgeon who has complications in less than 3% of those treated and that the hospital rate of complications be just as low.¹²

While carotid endarterectomy is often not done until several months after a TIA, a recent large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke because people are more likely to have a stroke in the first few days and weeks after a TIA. These results also point out why it is so important to see a doctor immediately if you have any signs of TIA.¹³

Carotid artery stenting is a procedure similar to one commonly used to open narrowed arteries in the heart. Angioplasty combined with a stent is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open.

Organizations

• Coronary Artery Disease
• Stroke

Citations

1. American Heart Association (2005). Heart Disease and Stroke Statistics: 2005 Update. Dallas: American Heart Association.

2. Pearson TA, et al. (2002). AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation, 106(3): 388–391.

3. Tanne D, et al. (2001). Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) registry: High triglycerides constitute an independent risk factor. Circulation, 104(24): 2892–2897.

4. Elkind MS, et al. (1999). Periodontal disease is associated with internal carotid artery plaque thickness. American Academy of Neurology 51st Annual Meeting Program (Proceedings). Neurology, 52(6, Suppl 2): A314–A315.

5. Saxena R, Koudstall PJ (2003). Anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-rheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

6. Stroke Council (2004). Statins after ischemic stroke and transient ischemic attack: An advisory statement from the Stroke Council, American Heart Association and American Stroke Association. Available online: http://stroke.ahajournals.org/cgi/content/full/35/4/1023.

7. Berger K, et al. (1999). Small to moderate alcohol consumption and decreased risk of stroke among U.S. male physicians. American Academy of Neurology 51st Annual Meeting Program (Proceedings). Neurology, 52(6, Suppl 2): A314.

8. Kasner SE, Morgenstern LB (2004) Cerebrovascular disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 4. New York: WebMD.

9. European Stroke Initiative Executive Committee (2000). European Stroke Initiative Recommendations for stroke management. Cerebrovascular Diseases, 10(5): 335–351.

10. PROGRESS Collaborative Group (2001). Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet, 358(9287): 1033–1040.

11. Albers G, et al. (1999). Supplement to the guidelines for the management of transient ischemic attacks. AHA Scientific Statement. Stroke, 30(11): 2502–2511.

12. Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.

13. Rothwell PM, et al., (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363(9413): 915–924.

Other Works Consulted

• American Heart Association/American College of Cardiology (2006). AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation, 113(19): 2363–2372.

• Brust J (2000). Transient ischemic attack. In LP Rowland, ed., Merritt's Neurology, 10th ed., pp. 231–232. Philadelphia: Lippincott Williams and Wilkins.

• Flemming K, Brown R (2000). Cerebral infarction and transient ischemic attacks. Postgraduate Medicine, 107(6): 55–83.

• Lees K, et al. (2000). ABC of arterial and venous disease. Secondary prevention of transient ischaemic attack and stroke. BMJ, 320(7240): 991–994.

• Sacco R, Elkind M (2000). Update on antiplatelet therapy for stroke prevention. Archives of Internal Medicine, 160(11): 1579–1582.

• Wityk R, Beauchamp N Jr (2000). Diagnostic evaluation of stroke. Neurologic Clinics, 19(2): 357–379.

Author:	Ellie Rodgers	Last Updated May 27, 2005
Medical Review:	Martin Gabica, MD - Family Medicine Barrie J. Hurwitz, MD - Neurology
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