Transient ischaemic attack (TIA): a mini-stroke warning in later life

The NHS describes a TIA as a temporary disruption in the blood supply to part of the brain, causing a lack of oxygen and sudden symptoms like those of a stroke, such as speech and visual disturbance and numbness or weakness in the face, arms and legs. The Stroke Association explains that a clot or fatty material in a blood vessel blocks the blood supply; when the blockage moves away or dissolves, blood flow returns and the symptoms stop.

The NHS adds that in the early stages it is not possible to tell whether you are having a TIA or a full stroke, which is why symptoms must be treated as an emergency from the start.

The NHS uses FAST: Face (one side may droop or the person cannot smile), Arms (cannot lift both arms and keep them up because of weakness or numbness in one arm), Speech (slurred or garbled, or unable to talk despite seeming awake, or trouble understanding), and Time to call 999. In an older person, signs may be noticed by a relative on a phone call, or the person may put a brief episode of clumsiness, slurred words or lost vision in one eye down to tiredness.

The NHS says that if you think you may have had a TIA before, the symptoms have passed and you did not seek advice, you should make an urgent GP appointment, and the GP will decide whether to refer you for hospital assessment. The Stroke Association says that if you did not get help at the time you can get an urgent GP appointment or go to an NHS urgent treatment centre.

The Stroke Association says that if you call 999 with stroke symptoms you should be taken to hospital. Even if symptoms disappear while waiting for the ambulance, the NHS says you still need assessment in hospital, with referral to a specialist within 24 hours of onset. An assessment helps doctors work out the cause and the best way to reduce the chance of a full stroke. The Stroke Association says doctors look for risk factors such as high blood pressure, heart problems or smoking and discuss your health with you.

How the specialist review is organised depends on local arrangements, so ask the team which tests are planned and when you will hear the results.

The NHS says a TIA is usually caused by a blood clot that formed elsewhere in the body and travelled to the brain's blood vessels, though pieces of fatty material or air bubbles can also be responsible. It lists smoking, high blood pressure, obesity, high cholesterol, regularly drinking an excessive amount of alcohol, atrial fibrillation and diabetes as things that increase the chance. People over 55 and people of Asian, African or Caribbean descent are at higher risk.

Atrial fibrillation is a particularly relevant cause in older people, because an irregular pulse may have no symptoms until a clot causes a TIA or stroke. A GP can check the pulse, and the pulse irregularity is one reason an ECG is often part of assessment.

The NHS says that although symptoms resolve in minutes or hours you still need treatment to prevent another TIA or a full stroke. It depends on individual circumstances such as age and medical history, and is likely to include lifestyle advice and medicine to treat the cause. In some cases a carotid endarterectomy, surgery to unblock the carotid arteries that supply the brain, may be needed.

The NHS lists maintaining a healthy weight, a balanced diet, regular exercise, limiting alcohol and not smoking as ways to lower the risk of TIA or stroke. For older adults, controlling blood pressure and reviewing the full medicine list with a GP or pharmacist after a TIA is a sensible follow-up step.

The Stroke Association says a TIA can have longer-term effects. Some people experience fatigue, which is extreme tiredness that does not always improve with rest, and many return to work with the right support. A TIA can be emotionally shocking, bringing worry about another episode and sometimes anxiety or low mood; it suggests sharing feelings, staying active, and contacting the GP or the Stroke Support Helpline if anxiety or low mood affects daily life. If physical or memory and thinking problems persist after a TIA, they should be raised at a clinic appointment or with the GP as more investigations may be needed.

On driving, the Stroke Association says you must not drive for at least one calendar month after a TIA or stroke, and should ask a doctor or occupational therapist whether and when you may restart; driving assessment centres can offer individual advice.