Transient ischemic attack

Last reviewed: 19 Apr 2022
Last updated: 04 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

  • patient/caregiver report of focal neurologic deficit
  • sudden onset and brief duration of symptoms
More key diagnostic factors

Other diagnostic factors

  • history of extracranial atherosclerosis
  • history of cardiac disease
  • unilateral symptoms
  • increased BP on presentation
  • focal neurologic deficit on exam
  • absence of positive symptoms (shaking, scotoma, spasm)
  • absence of headache
  • history of migraine
  • absence of seizure prior to neurologic deficit
  • no history of epilepsy
  • family or personal history of premature stroke, miscarriage, or venous thromboembolism
  • carotid bruit
Other diagnostic factors

Risk factors

  • atrial fibrillation
  • valvular disease
  • carotid stenosis
  • congestive heart failure
  • hypertension
  • diabetes mellitus
  • cigarette smoking
  • alcohol abuse
  • advanced age
  • patent foramen ovale (PFO)
  • hyperlipidemia
  • inactivity
  • obesity
  • hypercoagulability
More risk factors

Diagnostic investigations

1st investigations to order

  • blood glucose
  • chemistry profile
  • CBC
  • prothrombin time, INR, and activated PTT
  • ECG
  • brain MRI with diffusion
  • fasting lipid profile
More 1st investigations to order

Investigations to consider

  • head CT
  • ESR
  • telemetry/Holter monitor
  • echocardiogram with bubble study
  • carotid Doppler ultrasound
  • CT angiography
  • magnetic resonance angiography
  • transcranial Doppler
  • hypercoagulability studies
More investigations to consider

Treatment algorithm

ACUTE

atherosclerotic or small-vessel TIA

cardioembolic TIA without ischemic heart disease

cardioembolic TIA and ischemic heart disease

mechanical heart valves or rheumatic heart disease already on therapeutic anticoagulation

Contributors

Authors

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, MD

Assistant Professor

Department of Neurology

University of Colorado School of Medicine

Aurora

CO

Disclosures

KO is Site Principal Investigator for Amplatzer - PFO Post Approval Study; KO is also a member of the CureCADASIL Advisory Board.

Acknowledgements

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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