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

How Is Transient Ischemic Attack (TIA) Diagnosed?

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.

What Is the Treatment for Transient Ischemic Attack (TIA)?

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 FactorYes or NoTotal Points
Age > 60Yes
1 Point
0 Points
BP > 140/90 at initial readingYes
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
Duration60 minutes or more
10 to 59 minutes
 < 10 minutes
2 Points
1 Point
0 Points
1 Point
0 Points
ABCD2 Scoring
ABCD2 Score2 Day Stroke Risk
ABCD Scoring
ABCD Score7 Day Stroke Risk
6 or greater31%
Last Reviewed 11/21/2017

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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.

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