Transient Ischemic Attack (TIA, Mini-Stroke) - Diagnosis

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How is transient ischemic attack (TIA) diagnosed?

TIA is diagnosed by history and physical examination. Since most often the symptoms have resolved, the physician will need to complete a thorough history from the patient and family or friends who witnessed the event. The physical exam will include careful attention to the neurologic examination. This may include:

  • Assess mental status to make certain the patient is alert and oriented.
  • Check eye range of motion and facial movement to evaluate the cranial nerves (the short nerves that run from the brain to the face and neck).
  • Listen to the neck with a stethoscope to detect abnormal sounds that may signal narrowing of the blood vessel (carotid bruits).
  • Check for a regular heart rhythm to rule out the presence of atrial fibrillation.
  • Examine the arms and legs for tone, power, and sensation.
  • Check coordination and balance.

If the diagnosis of TIA is made, further urgent testing is usually recommended, including:

  • Electrocardiogram (EKG) to confirm a regular heart rate
  • Computerized tomography (CT scan) of the brain to assess bleeding
  • Carotid ultrasound to assess for narrowing of the large blood vessels in the neck
  • Some hospitals have CT angiogram available to evaluate the cerebral, carotid, and vertebral arteries. This test is the same as a CT of the head with the addition of intravenous dye into the blood vessels to the arteries.
  • Routine blood tests may include a complete blood count (CBC) to assess for anemia or low red blood cell count or too few platelets (thrombocytopenia). If the patient takes warfarin (Coumadin), a blood thinner, then an international normalized ratio (INR - a blood test that measures the degree of blood thinning) or prothrombin time (PT), may be performed to assess blood clotting measurements.
  • If there is concern that the heart is the source of blood clot or debris, then an echocardiogram or sound wave tracing of the heart may be considered.
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