Work up of transient ischemic attack — TIA

1. Big picture

A transient ischemic attack (TIA) is not a “minor event.” It is a neurological emergency because it is often the warning sign before a disabling ischemic stroke. The exam point is simple: a patient with TIA must be worked up like an acute stroke patient until proven otherwise.

The work-up has four goals:

1. Confirm that the event was really ischemic, not a mimic.

2. Localize the vascular territory: carotid/anterior circulation vs vertebrobasilar/posterior circulation.

3. Find the cause: large artery stenosis, cardioembolism, small vessel disease, dissection, hypercoagulability, etc.

4. Start immediate secondary prevention to prevent the