Transient Ischemic Attack (TIA, Mini-Stroke) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Transient ischemic attack (TIA) facts
- What is a transient ischemic attack (TIA)?
- What are the causes of transient ischemic attack (TIA)?
- What are the risk factors for transient ischemic attack (TIA)?
- What are the symptoms of transient ischemic attack (TIA)?
- How is transient ischemic attack (TIA) diagnosed?
- What is the treatment for transient ischemic attack (TIA)?
- What is the prognosis for transient ischemic attack (TIA)?
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 (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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