Diagnosis

One essential feature required for the diagnosis of a TIA is a focal loss of function. Hence, non-focal symptoms such as loss of consciousness - with or without an associated loss of vision, dizziness, generalised weakness, mental confusion, and urinary / faecal incontinence - cannot be accepted as evidence of a TIA.

Several focal symptoms should also be rejected if they occur in isolation. These include vertigo, diplopia, dysphagia, loss of balance, tinnitus, sensory symptoms confined to part of one limb or the face, amnesia, drop attacks and a scintillating scotoma (1).

The diagnosis of TIA is important since it identifies patients with a high risk of developing stroke and other vascular events as a consequence of thrombo-embolism.

NICE suggest (2):

Imaging for people who have had a suspected TIA or acute non-disabling stroke

Suspected TIA

• CT brain scanning should not be offered to people with a suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect
  
  
• after specialist assessment in the TIA clinic, consider MRI (including diffusionweighted and blood-sensitive sequences) to determine the territory of ischaemia, or to detect haemorrhage or alternative pathologies. If MRI is done, perform it on the same day as the assessment

Carotid imaging

• everyone with TIA who after specialist assessment is considered as a candidate for carotid endarterectomy should have urgent carotid imaging. [2008, amended 2019]

Reference:

• (1) Jonathan A. Edlow. Current Controversies in the Management of TIA. ACEP Scientific Assembly.
• (2) NICE (May 2019).Stroke and transient ischaemic attack in over 16s: diagnosis and initial management