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Transient Ischemic Attack (Mini-Stroke) (cont.)

Transient Ischemic Attack (TIA) Diagnosis

The diagnosis of TIA is most often made by history, since the neurologic deficits have most likely resolved before the patient presents for care. This history will also try to identify risk factors for heart disease and stroke:

Physical examination will include monitoring heart rate and rhythm and listening to the heart and lungs. Examination of the neck may include listening for bruits (abnormal sound made by blood rushing through narrowed blood vessels) or sounds made by blood rushing through narrowed blood vessels. A full neurologic exam will be undertaken and may include looking for weakness or numbness; assessing walk and coordination; and checking vision, hearing, speech, and language comprehension.

Other tests that may be considered include:

  • Electrocardiogram (EKG) and monitoring to look for irregular heart rhythms like atrial fibrillation.
  • CT scan of the head to look for bleeding in the brain. Strokes do not appear right away on a CT scan. It is a test to rule out bleeding, not to confirm a stroke or TIA.
  • Carotid ultrasound is a test to look for narrowing of the blood vessels in the anterior part of the neck that provide the majority of blood supply to the brain.

Basic blood tests may include a CBC (complete blood count) to look for anemia or problems with too many or too few platelets. Patients who take warfarin (Coumadin) (a blood thinner to prevent blood clots from atrial fibrillation) will have their blood tested to make certain the medication dosage is appropriate.

If there is concern that there may be clots coming from the heart or debris coming from heart valves, then an echocardiogram (ultrasound examination of the heart) may be indicated to help with the diagnosis as to the origin of the TIA.

Transient Ischemic Attack (TIA) Treatment

Treatment of TIA is aimed at preventing a future stroke. Simple scoring systems have been developed to estimate this risk and help decide whether a patient should be admitted to the hospital for observation or whether they can be discharged home for observation.

ABCD and ABCD2 (diabetes is considered) scores are commonly used predictors.

ABCD2 Risk Assessment
Risk Factor Yes or No Total Points
Age > 60 Yes
No
1 Point
0 Points
BP > 140/90 at initial reading Yes
No
1 Point
0 Points
Clinical features of TIA: Unilateral (one sided) weakness with or without speech impairment OR
Speech disturbance without weakness
2 Points


1 Point
 
Duration 60 minutes or more
10 to 59 minutes
 < 10 minutes
2 Points
1 Point
0 Points
Diabetes Yes
No
1 Point
0 Points
ABCD2 Scoring
ABCD2 Score 2 Day Stroke Risk
0-3 1%
4-5 4%
6-7 8%
ABCD Scoring
ABCD Score 7 Day Stroke Risk
0-4 0.4%
5 12%
6 or greater 31%
Medically Reviewed by a Doctor on 6/2/2014

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Read What Your Physician is Reading on Medscape

Trasient Ischemic Attack »

A transient ischemic attack (TIA) can be considered an acute episode of temporary neurologic dysfunction caused by a vascular occlusion.

Read More on Medscape Reference »


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