Transient Ischemic Attack – Diagnosis and Treatment
Diagnosis
Doctors diagnose a transient ischemic attack (TIA), also called a mini-stroke or warning stroke, with a fast and careful evaluation.
They use several tests to find the cause of TIA symptoms, such as numbness, weakness, slurred speech, confusion, trouble with balance, or vision changes.
Doctors also look for risk factors like high blood pressure, high cholesterol, or diabetes to guide treatment and prevention.
Physical and Neurological Exams
A healthcare professional begins with a detailed physical checkup and a neurological exam. The doctor checks coordination, strength, speech, vision, reflexes, and balance.
The doctor may listen to the neck arteries with a stethoscope. A swishing sound, called a bruit, can hint at carotid artery stenosis, which means narrowing due to plaque.
An eye check with an ophthalmoscope can spot small blockages in blood vessels at the back of the eye.
Imaging the Brain and Vessels
Doctors use different scans to get clear pictures of the brain and blood vessels.
| Test | What it shows | Why it’s used |
|---|---|---|
| CT Scan | Brain and blood vessels | Finds bleeding or blockage; checks for stroke damage |
| CT Angiography (CTA) | Vessels in the head and neck | Detects narrowing or blockages with contrast dye |
| MRI | Detailed brain structure | Shows early TIA changes and other problems |
| Magnetic Resonance Angiography (MRA) | Arteries in neck and brain | Pinpoints narrowed vessels, sometimes with contrast dye |
Carotid Artery Ultrasound
Carotid ultrasound uses sound waves to view blood flow in the main neck arteries. This non-invasive exam helps doctors find blockages or narrowing in the carotid arteries, a leading cause of TIA.
It shows if plaque or a clot is slowing blood flow to the brain.
Heart Assessments
Doctors check the heart for clots or other issues if they think a heart problem caused the TIA.
- Transthoracic Echocardiogram (TTE): A probe moves across the chest, using sound waves to make images of the heart.
- Transesophageal Echocardiogram (TEE): A flexible probe goes into the esophagus, close to the heart. TEE gives more detailed pictures and can better show small blood clots.
Evaluating Blood Vessels
Doctors sometimes use arteriography, also called angiography, to get a closer look at brain arteries. A thin tube, or catheter, is inserted through a blood vessel to an artery in the neck.
Doctors inject dye to make the arteries show up on X-rays. This test helps find blockages or changes that regular scans may miss.
Blood and Other Tests
Doctors check blood pressure and may order blood tests for cholesterol, blood sugar, and sometimes homocysteine levels. These tests help find risk factors that can increase the chance of another TIA or a major stroke.
Diagnostic Tool Overview
| Symptom/Sign | Test Usually Ordered | Common Findings |
|---|---|---|
| Numbness, weakness, speech difficulty | MRI, CT scan, neurological exam | Signs of interrupted blood flow |
| Loss of balance, dizziness | MRI, carotid ultrasound | Issues with coordination or flow |
| Vision changes, confusion | Ophthalmoscope, MRA | Possible eye or vessel blockages |
| Heart cause suspected | TTE, TEE, electrocardiogram | Clots or rhythm problems |
Additional Details
Doctors may use other tests when diagnosis is unclear or risk factors need more study.
- Blood pressure measurement
- Cholesterol checking
- CT coronary angiogram for heart vessels
- Electrocardiogram (ECG) to check heart rhythm
Each test helps the doctor understand the situation and manage symptoms.
Approaches to Treatment
Medication Options
Doctors often use medication to help prevent a stroke after a transient ischemic attack. The choice depends on the cause and how severe the artery blockage is.
| Type of Medicine | Main Use |
|---|---|
| Antiplatelets | Stop platelets from forming clots |
| Anticoagulants | Reduce clotting from blood proteins |
Antiplatelet medicines lower the chance of blood clots by making platelets less sticky. This means blood cells are less likely to clump and block blood vessels.
- Aspirin is used most often because it works well, costs less, and has fewer side effects.
- A P2Y12 inhibitor can be taken instead of aspirin, or sometimes together with aspirin for about a month.
- For some people with a blockage in a major artery, a phosphodiesterase III inhibitor may be used along with aspirin or a P2Y12 inhibitor.
- Sometimes, doctors prescribe a P2Y12 inhibitor together with aspirin for a short time.
- A mix of low-dose aspirin and a platelet aggregation inhibitor (e.g., dipyridamole) can also help.
Anticoagulant medicines are used when needed. These make it harder for blood proteins to form clots.
- Anticoagulants are examples of blood thinners used to prevent clots. Doctors typically use heparin only for short periods and not often for TIAs.
- For people with heart rhythm problems like atrial fibrillation, doctors may prescribe direct oral anticoagulants (DOACs). These newer medications have a lower risk of causing major bleeding compared to older anticoagulants.
A healthcare professional monitors these medications to make sure the right dose is given and to avoid problems.
Surgical Procedures to Clear Arteries
Doctors may suggest surgery if a person has a very tight narrowing in one of the carotid arteries in the neck. One common surgery is carotid endarterectomy.
In this operation, the surgeon opens the artery, removes the fatty buildup called plaque, and then closes the artery. This improves blood flow to the brain and lowers the risk of another TIA or a full stroke.
Doctors usually recommend this surgery when the narrowing is serious or when medicines are not enough to keep the artery open.
Widening the Artery with Angioplasty
Doctors can treat blocked or narrowed arteries with carotid artery ballooning and stenting, also called angioplasty with stent placement.
- A small balloon is put into the narrowed area of the artery.
- The balloon is gently inflated to push aside the plaque and open up the vessel.
- A tiny wire tube called a stent is placed to keep the artery open.
Doctors use this approach for people who are not good candidates for surgery or when the narrowing is in a hard-to-reach spot.
Getting Ready for Your Visit
Steps You Can Take
Prepare in advance by gathering:
- A list of medical conditions, such as high blood pressure, diabetes, heart disease, obesity, or atrial fibrillation.
- Information about family history, focusing on stroke, heart disease, atherosclerosis, and blood clots.
- Details about any medicines, vitamins, or supplements.
- Notes on recent symptoms, including possible signs of a transient ischemic attack.
- Lifestyle habits, like diet, smoking, exercise, and physical inactivity.
- Questions about stroke prevention, cholesterol management, and managing risk factors like high cholesterol or high blood pressure.
Tip: Write these details down to share with the healthcare provider.
What the Doctor Will Likely Do
- The doctor will review your medical history and stroke risk factors. They will also ask about any family history of stroke or heart problems.
- The doctor will check your blood pressure. They will ask about diabetes, cholesterol, and other conditions that increase stroke risk.
- The doctor will ask questions about your symptoms or any recent events.
- The doctor may recommend tests, such as blood tests for sugar and cholesterol levels. You may need to fast before these tests.
Be ready to talk about ways to lower your stroke risk and get advice on preventing transient ischemic attacks.
