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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

Notes:

  • 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

Reference:


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