Transient ischemic attack

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Author: Mikael Häggström [notes 1]
The American Heart Association and the American Stroke Association (AHA/ASA) define TIA as a brief episode of neurological dysfunction with a vascular cause, with clinical symptoms typically lasting less than one hour, and without evidence of infarction on imaging.[1]


How soon

According to guidelines from the American Heart Association and American Stroke Association Stroke Council, patients with symptoms indicating TIA should have head imaging within 24 hours of symptom onset.[2]

Choice of modality

MRI of the head is a better imaging modality for TIA than a CT of the head, as it is better able to pick up both new and old ischemic lesions than CT. CT of the head, however, is more widely available and can be used particularly to rule out intracranial hemorrhage.[3] MRI should include diffusion sequences”,[2], since these can help further localize the area of ischemia and can serve as prognostic indicators.[4]


The main purpose of the investigation is to rule out stroke.

Further imaging

Once a diagnosis of transient ischemic attack has been made, vessels in the head and neck may be evaluated to look for atherosclerotic lesions that may benefit from interventions such as carotid endarterectomy. The vasculature can be evaluated through the following imaging modalities: magnetic resonance angiography (MRA), CT angiography (CTA), and carotid ultrasonography/transcranial doppler ultrasonography.[2] Carotid ultrasonography is often used to screen for carotid artery stenosis, as it is more readily available. Since these imaging methods have variable sensitivities and specificities, more than one may be needed to help confirm the diagnosis (for example: screen for the disease with ultrasonography, and confirm with CTA).[5]

How soon

In Swedish practice, generally within 1 to 2 weeks, and not during hours of only emergency coverage.[notes 2]


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
  2. NU Hospital Group, Sweden


  1. Easton, JD; Saver, JL; Albers, GW; Alberts, MJ; Chaturvedi, S; Feldmann, E; Hatsukami, TS; Higashida, RT; et al. (June 2009). "Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. ". Stroke: A Journal of Cerebral Circulation 40 (6): 2276–93. doi:10.1161/strokeaha.108.192218. PMID 19423857. 
  2. 2.0 2.1 2.2 Easton JD, Saver JL, Albers GW et al. (2009). "Definition and evaluation of transient ischemic attack ". Stroke 40 (6): 2276–2293. doi:10.1161/strokeaha.108.192218. PMID 19423857. 
  3. Simmons B, Cirignano B, Gadegbeku A (Sep 2012). "Transient Ischemic Attack: Part I. Diagnosis and Evaluation ". Am Fam Physician 86 (6): 521–526. 
  4. Adams HP Jr, del Zoppo G, Alberts MJ et al. (2007). ""Guidelines for the early management of adults with ischemic stroke " a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists [published corrections appear in Stroke. 2007;38(9) e96, and Stroke. 2007;38(6) e38] ". Stroke 38 (5): 1655–1711. doi:10.1161/strokeaha.107.181486. 
  5. . Final Recommendation Statement: Carotid Artery Stenosis: Screening - US Preventive Services Task Force (in en).