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Transient ischemic attack

Last reviewed: 21 Oct 2024
Last updated: 07 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • patient/caregiver report of focal neurologic deficit
  • sudden onset and brief duration of symptoms
Full details

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
Full details

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
Full details

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
Full details

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
Full details

Treatment algorithm

ACUTE

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
Jennifer Simpson

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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