Last edited 06/2019

These are designed to ascertain the cause of the transient ischaemic attack and to assess risk factors for vascular disease.

Investigations include:

  • Blood tests:
    • FBC
    • ESR or CRP
    • platelets
    • urea
    • blood glucose
    • syphilis serology
  • chest X-ray
  • ECG and 24 hour tape to look for paroxysmal arrhythmia
  • transesophageal & transthoracic echocardiography (2)
  • carotid duplex scanning " carotid angiography (3)
  • CT scan - to recognize subarachnoid haemorrhages, intracranial haemorrhages, or subdural hematoma, to differentiate haemorrhages from tumors and other masses (2)

With respect to brain imaging and carotid imaging NICE suggest (1):

  • do not offer CT brain scanning to people with a suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect

  • after specialist assessment in the TIA clinic, consider MRI (including diffusionweighted and blood-sensitive sequences) to determine the territory of ischaemia, or to detect haemorrhage or alternative pathologies. If MRI is done, perform it on the same day as the assessment

  • carotid imaging
    • everyone with TIA who after specialist assessment is considered as a candidate for carotid endarterectomy should have urgent carotid imaging


  • examples where brain imaging is helpful in the management of TIA are:
    • people being considered for carotid endarterectomy where it is uncertain whether the stroke is in the anterior or posterior circulation
    • people with TIA where haemorrhage needs to be excluded, for example long duration of symptoms or people on anticoagulants
    • where an alternative diagnosis (for example migraine, epilepsy or tumour) is being considered
  • type of brain imaging for people with suspected TIA
    • people who have had a suspected TIA who need brain imaging (that is, those in whom vascular territory or pathology is uncertain) should undergo diffusion-weighted MRI except where contraindicated, in which case CT (computed tomography) scanning should be used