Summary
Definition
History and exam
Key diagnostic factors
- patient/caregiver report of focal neurologic deficit
- sudden onset and brief duration of symptoms
Other diagnostic factors
- history of extracranial atherosclerosis
- history of cardiac disease
- unilateral symptoms
- dysphasia
- ataxia, vertigo, or loss of balance
- vision loss or visual field deficit
- binocular diplopia
- increased BP on presentation
- absence of positive symptoms (shaking, scotoma, spasm)
- family or personal history of premature stroke, miscarriage, or venous thromboembolism
- carotid bruit
Risk factors
- atrial fibrillation
- valvular disease
- carotid stenosis
- intracranial stenosis
- congestive heart failure
- hypertension
- hyperlipidemia
- diabetes mellitus
- cigarette smoking
- alcohol abuse
- advanced age
- patent foramen ovale (PFO)
- inactivity
- obesity
- hypercoagulability
Diagnostic tests
1st tests to order
- blood glucose
- chemistry profile
- CBC
- prothrombin time, INR, and activated PTT
- ECG
- brain MRI with diffusion
- fasting lipid profile
Tests to consider
- head CT
- erythrocyte sedimentation rate (ESR)
- telemetry/Holter monitor
- echocardiogram ± bubble study
- carotid Doppler ultrasound
- CT angiography
- magnetic resonance angiography (MRA)
- transcranial Doppler
- hypercoagulability studies
Treatment algorithm
small-vessel TIA
cardioembolic TIA
stenosis of a major intracranial artery
mechanical heart valves or rheumatic heart disease already on therapeutic anticoagulation
Contributors
Authors
Lucia Chen, MD
Vascular Neurology Fellow
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
Disclosures
LC declares that she has no competing interests.
Jennifer Simpson, MD
Associate Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
Disclosures
JS declares that she has no competing interests.
Karen Orjuela, MSCR, FAAN
Assistant Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
Disclosures
KO has received research funding from the Bristol Myers Squibb Foundation and Abbott.
Acknowledgements
Dr Lucia Chen, Dr Jennifer Simpson, and Dr Karen Orjuela wish to gratefully acknowledge Dr Ethan Cumbler, a previous contributor to this topic.
Disclosures
EC declares that he has no competing interests.
Peer reviewers
Ronan Factora, MD
Staff Physician
Section of Geriatric Medicine
Cleveland Clinic
Cleveland
OH
Disclosures
RF declares that he has no competing interests.
Tony Rudd, MD
Stroke Physician
Guy's and St Thomas' NHS Foundation Trust
Stroke Programme Director
Royal College of Physicians
London
UK
Disclosures
TR declares that he has no competing interests.
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