Mini-stroke - Diagnosing a transient ischaemic attack

It's important to be assessed by a healthcare professional as soon as possible if you think you have had a transient ischaemic attack (TIA).

After an initial assessment of your symptoms, you may be referred to a specialist for further tests to help determine the cause of the TIA.

A TIA is a warning sign that you are at risk of having a full stroke in the near future, and a detailed assessment can help your doctor decide the best way to reduce this risk.

Initial assessment

TIAs are often over very quickly, so you may not have any symptoms by the time you see a doctor.

You will be asked about the symptoms you experienced during the TIA and how long they lasted. This will help to rule out other conditions that may have caused your symptoms.

Even if you no longer have symptoms, a neurological examination may still be needed. This involves simple tasks designed to check your strength, sensation and co-ordination skills.

Referral to a specialist

If a TIA is suspected, you will be referred to a specialist for further tests. If you are at a particularly high risk of having a stroke or another TIA in the near future, you should be seen within 24 hours. People at a lower risk should be seen within seven days.

You will normally be offered aspirin to take while you are waiting for specialist assessment, as this can help to reduce your risk of having a stroke or another TIA in the meantime.

It is likely that you will be referred to a neurologist (a doctor who specialises in conditions that affect the brain and spine), or a consultant who specialises in strokes. This may be in a specialist stroke or TIA clinic.

Tests

Several tests may be carried out to confirm a TIA and look for underlying problems that may have caused it. Some of these tests are described below.

Blood pressure tests

Your blood pressure will be checked, because high blood pressure (hypertension) can lead to TIAs.

Blood tests

You might need blood tests to determine whether you have high cholesterol, and to check if you have diabetes.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures your heart's electrical activity using a number of electrodes (small, sticky patches) attached to your skin.

An ECG can detect abnormal heart rhythms, which may be a sign of conditions such as atrial fibrillation (where your heart beats irregularly), which can increase your risk of TIAs.

Carotid ultrasound

A carotid ultrasound scan can show if there is narrowing or blockages in the neck arteries leading to your brain.

A small probe (transducer) sends high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.

Brain scans

Brain scans are not always necessary if you have had a TIA. They are normally only carried out if it's not clear which part of your brain was affected.

A magnetic resonance imaging (MRI) scan will most often be carried out in these cases. This type of scan uses a strong magnetic field and radio waves to create an image of your brain.

Occasionally, a computerised tomography (CT) scan may be used if an MRI scan is not suitable for you. This type of scan uses a series of X-rays to produce an image of the inside of brain.