An Update on Transient Ischemic Attacks

Janice Hinkle

Disclosures

J Neurosci Nurs. 2005;37(5):243-248. 

In This Article

Assessment

A neurological assessment is most commonly based on both subjective and objective data. Often there are no objective findings by the time the patient with TIA is seen by a healthcare professional (Johnston, 2002). Therefore, a careful medical history is crucial, as the diagnosis is often based on clinical history alone (Bader & Littlejohns, 2004; Johnston, 2002). The patient or an accompanying family member may report any of the symptoms outlined in Table 1 . Careful questioning may be needed to elicit recall of the timing and exact nature of the event.

Nonischemic causes of the attack must be ruled out during the initial evaluation. Many types of seizures can mimic TIA (Schulz & Rothwell, 2002). Medication reported to be associated with TIA include sildenafil (Viagra) (Morgan, Alhatou, Oberlies, & Johnston, 2001) and risperidone (Risperdal; U.S. Department of Health and Human Services [DHHS], 2003). There are many other possible causes that should be considered; Table 2 contains a list compiled from existing literature.

The recommended initial diagnostic evaluation for TIA patients more than 50 years old includes both laboratory and neurodiagnostic studies (Bader & Littlejohns, 2004). Any diagnostic evaluation, regardless of patient age, must be individualized. Recommended laboratory studies include

  • complete blood count with platelet count

  • chemistry profile (with fasting cholesterol level and glucose tolerance)

  • prothrombin time and activated partial thromboplastin time

  • erythrocyte sedimentation rate (ESR) with syphilis serology

  • lipid profile.

Diagnostic studies include an electrocardiogram (ECG; Albers & Easton, 2001; Feinberg et al., 1994); noncontrast cranial CT, particularly in hemispheric TIAs (Albers & Easton; Feinberg, et al.); and noninvasive arterial imaging (e.g., ultrasound, magnetic resonance angiography; Albers & Easton; Bader & Littlejohns; Feinberg et al.). Patients also need to be evaluated for asymptomatic coronary artery disease (Adams et al., 2003).

Although there are recommendations for the diagnostic evaluation of patients following TIA, there is no current directive as to whether the evaluation needs to be done on an inpatient or outpatient basis (Brown et al., 1994; Feinberg et al., 1994; Moore, 2001). There is agreement that the workup needs to be completed within 24 hours; therefore patients will need to be hospitalized if it is not possible to complete the diagnostic studies within that time. For example, the wait for outpatient CT may be several days in some settings.

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