Fast Five Quiz: Stroke

Richard H. Sinert, DO

Disclosures

November 06, 2020

Ruling out metabolic or drug-induced causes of symptoms consistent with a TIA is important. Initial assessment is aimed at excluding emergency conditions that can mimic a TIA (eg, hypoglycemia, seizure, intracranial hemorrhage). A fingerstick blood glucose test should be performed and blood drawn for a complete blood cell count, coagulation studies, and serum electrolyte levels. Obtain a 12-lead ECG with rhythm strip and evaluate for symptomatic arrhythmias or evidence of ischemia.

Brain imaging is recommended within 24 hours of symptom onset. Although MRI with diffusion-weighted imaging is preferred, noncontrast CT of the head is a reasonable first choice if MRI is not readily available. Carotid Doppler ultrasonography is appropriate, but not before CT of the head or MRI with diffusion-weighted imaging is obtained.

Screening for hypercoagulable states may be performed, particularly in younger patients with no known vascular risk factors; however, this practice is not routinely recommended for all patients with suspected TIA.

Vascular imaging for TIA includes Doppler ultrasonography, CTA, and MRA. CTA is of increasing value in identifying occlusive disease in the cerebrovascular circulation. MRA is another alternative for imaging vessels in both the brain and the neck. Conventional catheter angiography can be performed when the other modalities are unavailable or yield discordant results.

Read more about the workup of TIA.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Hemorrhagic Stroke, Ischemic Stroke, and Transient Ischemic Attack.

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