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.
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Medical and family history
The symptoms of a TIA are typically of short duration and, in the majority of cases, there are no notable symptoms that are evident 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 he/she experienced. Common symptoms indicative of TIA that may be reported include abnormality of facial muscles, difficulty speaking and/or weakness in the arms.
Obtaining a history of other health conditions should also occur, as a TIA is strongly linked to cardiovascular disease (CVD) and diabetes. It is also important consider whether the patient has a family history of TIA and/or stroke, as patients with close family members who have been affected by these conditions are at a great risk.
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 are also usually used to detect any abnormalities that may have been responsible for causing the symptoms of TIA.
A high level of cholesterol in the blood is often responsible for a TIA, as it increases the likelihood of atherosclerotic plaque development and narrowing of the blood vessels. Additionally, high blood glucose levels and related hemoglobin factors can also be indicative of uncontrolled diabetes, which is a significant risk factor for both TIA and stroke.
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.
Ultrasonography of the carotid artery enables the visualization of the arteries and provides 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.
Scans of the brain are not necessary in all TIA cases; however, they may be useful in determining 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, as it generates a three-dimensional (3D) image of the brain and its related arteries with a strong magnetic field. Alternatively, a computerized tomography (CT) scan can be utilized to create a similar image of the brain and arteries.
When making a diagnosis of a TIA, it is prudent to consider other health conditions that can present with similar symptoms in order to ensure that the correct diagnosis is drawn and an appropriate management plan is created. Other conditions that have similar symptoms to a TIA 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.