Medical History and Physical Exam for a Suspected TIA

The diagnosis of transient ischemic attack (TIA) typically is based on your medical history rather than a physical exam, because symptoms usually have gone away by the time you seek medical attention.

The onset of one or more of the following symptoms without any known injury to the head suggests that you may have had a TIA:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body
• Sudden vision changes
• Sudden trouble speaking
• Sudden confusion or trouble understanding simple statements
• Sudden problems with walking or balance
• A sudden, severe headache that is different from past headaches

Other causes of these symptoms need to be considered too. When more than one symptom is present, the pattern of the symptoms can be used to decide whether they were likely to be caused by a TIA. The doctor will note which symptoms were present and which areas of the body were involved. This may help the doctor find out which part of the brain was affected. He or she also will note how long the symptoms lasted. Symptoms of a TIA usually go away in minutes (10 to 20 minutes).

The doctor also may ask questions to find out other possible causes for the symptoms, such as flu, inner ear problems, stress, rapid breathing, low blood sugar (if you have diabetes), or seizure.

Other information from the medical history often includes:

• Any history of previous TIAs.
• Any family history of TIAs or strokes.
• The presence of risk factors for TIA or stroke, such as high blood pressure (hypertension), smoking, diabetes, high cholesterol, and heart disease, especially atrial fibrillation.
• Any history of other diseases that may increase the risk of TIA or stroke.
• What medicines you are taking.
• A recent injury to the head or neck.
• The use of oral contraceptives (birth control pills).
• Any drug or alcohol use.
• Any history of migraine headaches.

Your doctor usually will do a physical exam to check your:

• Face, arms, and legs for symptoms of numbness, tingling, weakness, or paralysis.
• Vision for dimness, blurring, double vision, or loss of vision in one or both eyes, which is often described as a feeling that a shade is being pulled down over your eyes.
• Speech for difficulty saying words.
• Ability to understand words.
• Balance and the way you walk for any unsteadiness or weakness in your legs.

The doctor also will:

• Check your blood pressure.
• Listen for the swishing sound—a bruit (say "broo-E")—of blood flow through an artery in your neck. Abnormal sounds heard in a blood vessel may be a sign that a blood vessel is partially blocked, which may increase your risk for having a TIA or stroke.
• Check for signs of heart failure, such as swollen neck veins or crackling sounds in your lungs. Heart failure increases your risk of having a TIA or stroke.
• Listen to your heart for rapid, irregular heartbeats (atrial fibrillation).
• Check for decreased pulses in your neck, arms, and legs (signs of blood vessel disease).

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