Evaluation and Treatment
Patients who arrive in the TIA unit with suspected TIA are immediately evaluated by a team of providers. The focus is on differentiating a TIA from stroke or other conditions with symptoms that are the same as or similar to stroke.
We obtain a history of the onset of symptoms, examine the patient, use neuroimaging to examine the brain and its blood vessels, and perform an evaluation of the heart.
The resulting diagnosis allows us to quickly ascertain clinical risk criteria to identify patients at highest and lowest risk of stroke. Those experiencing a TIA are treated immediately with medication, and then monitored for 24 hours in the unit.
Patients undergo screening that includes:
- Physical examination to assess for loss of function in strength, speech or sensation
- Comprehensive history to assess for risk factors indicative of elevated risk for stroke after a TIA, such as advanced age, diabetes, hypertension, carotid stenosis and prior TIA or stroke
- Laboratory testing
- Advanced neuroimaging (most often MRI) within 24 hours of symptom onset
- Intracranial and extracranial vascular imaging, possibly including carotid ultrasound and transcranial Doppler ultrasound, CT angiography or MR angiography
- Electrocardiogram assessment
- Echocardiogram for patients with a history or evidence of cardiac disease and for patients in whom other causes have been ruled out
- 30-day heart rhythm monitoring
- Pre-discharge education
- Follow-up care with a neurologist and the patient’s primary care physician
- A telephone call after 30 days to ask about recurrent events and feedback on care
- Follow-up assessment for compliance with medications and lifestyle changes such as weight management, smoking cessation, exercise, nutrition, etc.
- Screening for cognitive impairment and for depression, with treatment targeted before discharge
The Andrew F. Anderson Emergency Center has an MRI system located within the center, which facilitates prompt screening of patients with suspected TIA. Our goal is to ensure that all TIA patients are evaluated thoroughly as quickly as possible to minimize short-term stroke risk.
Risk Factors for TIA and Stroke
- high blood pressure
- high cholesterol
- diabetes
- heart disease, especially atrial fibrillation
- smoking
- physical inactivity
Other factors such as age (older than 55), ethnicity, and family history of stroke can contribute to one’s risk of stroke