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Tests and diagnosis
By Mayo Clinic staffBecause a transient ischemic attack is short-lived, your doctor may diagnose a TIA based just on the medical history of the event rather than on anything found during a general physical and neurological examination. To help determine the cause of your TIA and to assess your risk of stroke, your doctor may rely on the following:
- Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes, and high levels of the amino acid homocysteine. Your doctor may also use a stethoscope to listen for a whooshing sound (bruit) over your arteries that may indicate atherosclerosis. Or your doctor may observe cholesterol fragments (emboli) in the tiny blood vessels of your retina, at the back of your eye, during an eye examination using an ophthalmoscope.
- Carotid ultrasonography. A wand-like device (transducer) sends high-frequency sound waves into your neck. After the sound waves pass through your tissue and back, your doctor can analyze images on a screen to look for narrowing or clotting in the carotid arteries.
- Computerized tomography (CT) scanning. CT scanning of your head uses X-ray beams to assemble a composite, 3-D look at your brain.
- Computerized tomography angiography (CTA) scanning. Scanning of the head may also be used to noninvasively evaluate the arteries in your neck and brain. CTA scanning uses X-rays, similar to a standard CT scan of the head, but may also involve injection of a contrast material into a blood vessel.
- Magnetic resonance imaging (MRI). This procedure, which uses a strong magnetic field, can generate a composite, 3-D view of your brain.
- Magnetic resonance angiography (MRA). This is a method of evaluating the arteries in your neck and brain. It uses a strong magnetic field, similar to MRI.
- Transesophageal echocardiography (TEE). During this procedure, a flexible probe with a transducer built into it is placed in your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, very clear, detailed ultrasound images can be created, allowing a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.
- Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-ray imaging. A radiologist inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then, the radiologist injects a dye through the catheter to provide X-ray images of the arteries in your brain.
References
- Transient ischemic attack. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4781. Accessed Dec. 30, 2008.
- Wu CM, et al. Early risk of stroke after transient ischemic attack: A systematic review and meta-analysis. Archives of Internal Medicine. 2007;167:2417.
- Stroke risk factors. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4716. Accessed Dec. 30, 2008.
- Sacco RL, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke. 2006;37:577.
- NINDS transient ischemic attack information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/tia/tia.htm. Accessed Dec. 31, 2008.
- Lewandowski CA, et al. Transient ischemic attack: Definitions and clinical presentations. Annals of Emergency Medicine. 2008;52:S7.
- Ischemic stroke. http://www.merck.com/mmpe/sec16/ch211/ch211b.html?qt=transient%20ischemic%20attack&alt=sh#sec16-ch211-ch211b-446. Accessed Dec. 31, 2008.
- Sudlow C. Dipyridamole with aspirin is better than aspirin alone in preventing vascular events after ischaemic stroke or TIA. British Medical Journal. 2007;334:901.
