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Clinical investigations from the RACP

How to investigate patients following a transient ischaemic attack

John Worthington

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Abstract

Urgent and comprehensive investigation, with expert opinion and management, reduces the high early risk of stroke following a TIA. CT scans, 12-lead ECGs and carotid imaging are the essential investigations in the first hours after a suspected TIA.

Key Points

  • Urgent and comprehensive investigation of patients can reduce the high early risk of stroke following a TIA.
  • All patients with stroke-like neurological symptoms should present to hospital urgently, including those with a TIA in whom symptoms and signs have resolved or are resolving.
  • The aims of investigations are initially to exclude haemorrhage and then to determine the possible sources of thromboembolism and the presence of treatable cardiovascular risk factors.
  • CT scans, 12-lead ECGs and carotid imaging are essential investigations in the first hours after a suspected TIA.
  • Blood testing, echocardiography, MRI and Holter or bedside cardiac monitoring are likely to improve diagnosis and better inform treatment.
  • About a quarter of patients with stroke-like symptoms will have a non-neurovascular mimic disorder requiring different investigations and management.

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