Transient Ischemic Attack Diagnosis

If transient ischemic attack (TIA) is suspected, immediate assessment is required to confirm the diagnosis and create a suitable management plan for the prevention of future attacks or stroke.

Medical and Family History

The symptoms of TIA are typically of short duration and in the majority of cases there are no notable symptoms present upon patient presentation. As a result, it is important to create a thorough history of the event by asking the patient to describe the symptoms experienced. Common symptoms indicative of TIA that may be reported include abnormality of facial muscles, difficulty speaking and weakness in the arms.

History of other health conditions should also be discussed, as TIA is strongly linked to cardiovascular disease and diabetes. It is also important consider family history of TIA and stroke, as patients with close family members affected by these conditions are more likely to suffer themselves.

Blood pressure

Blood pressure is routinely tested in patients that are suspected to have had a TIA, to investigate the involvement of hypertension.

Hypertension has a notable effect on the risk of TIA and stroke. If it is likely to have played a role in the attack, medication management can be utilized to control hypertension and reduce the risk of future attacks.

Blood tests

Blood tests are usually used to detect any abnormalities that may have been responsible for causing the symptoms of TIA.

High level of cholesterol in the blood stream is often responsible, as it increases the likelihood of atherosclerotic plaque development and narrowing of the blood vessels. Additionally, high blood glucose and related hemoglobin factors can be indicative of uncontrolled diabetes, which is a significant risk factor for both TIA and stroke.

Echocardiography (ECG)

In some cases, a transthoracic or transesophageal echocardiogram can help to determine the involvement of the heart and atrial fibrillation in causing the TIA. This involves the placement of a transducer across the chest or in the esophagus of the patient, which emits ultrasound waves to depict the activity of the heart.

Carotid Ultrasound

Ultrasonography of the carotid artery enables the visualization of the arteries and any evidence of blood clots of vessel narrowing present. This technique uses high frequency sound waves directed towards the neck, which are analyzed after they have passed through the area for evidence of disruption.

Brain Scan

Scans of the brain are not necessary in all cases, but may be useful to determine the area of the brain that was affected by the attack.

Magnetic resonance imaging (MRI) is the most common type of scan that is used for this purpose, which generates a 3-dimensional image of the brain or related arteries with a strong magnetic field. Alternatively, computerized tomography (CT) scan can be utilized to create a similar image of the brain and arteries.

Differential Diagnosis

When making a diagnosis of transient ischemic attack, it is prudent to consider other health conditions that present with similar symptoms to ensure the correct diagnosis is drawn and an appropriate management plan is created. Other conditions that have related symptoms include:

• Migraine with aura
• Partial seizure of the brain in the parietal area
• Hypertensive encephalopathy
• Subdural hematoma
• Brain tumor
• Demyelinating disease

However, with appropriate questioning about the history of symptoms and medical tests to confirm TIA, an accurate diagnosis can usually be made.

References

• http://www.nhs.uk/Conditions/Transient-ischaemic-attack/Pages/Diagnosis.aspx
• http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Transient_ischaemic_attack
• http://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/basics/tests-diagnosis/con-20021291
• http://www.ncbi.nlm.nih.gov/pubmed/18655915