Exams and Tests

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:

• high blood pressure,
  
  
• high cholesterol,
  
  
• diabetes,
  
  smoking, and
  
  
• family history.

Physical examination will include monitoring heart rate and rhythm and listening to the heart and lungs. Examination of the neck exam may include listening for bruits (abnormal sound) 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 or sound wave examination of the heart may be indicated to help with the diagnosis as to the origin of the TIA.