Diagnosis

A prompt evaluation of your symptoms is vital in diagnosing the cause of your TIA and deciding on a method of treatment. To help determine the cause of your TIA and to assess your risk of a stroke, your doctor may rely on the following:

• Physical exam and tests. Your doctor will perform a physical exam and a neurological exam. The doctor will test your vision, eye movements, speech and language, strength, reflexes, and sensory system. Your doctor may use a stethoscope to listen to the carotid artery in your neck. A whooshing sound (bruit) may indicate atherosclerosis. Or your doctor may use an ophthalmoscope to look for cholesterol fragments or platelet fragments (emboli) in the tiny blood vessels of the retina at the back of your eye.

  Your doctor may check for risk factors of a stroke, including high blood pressure, high cholesterol levels, diabetes and in some cases high levels of the amino acid homocysteine.

• Carotid ultrasonography. If your doctor suspects that the carotid artery may be the cause of your TIA, a carotid ultrasound may be considered. A wand-like device (transducer) sends high-frequency sound waves into your neck. After the sound waves pass through your tissue and back, your doctor can analyze images on a screen to look for narrowing or clotting in the carotid arteries.
• Computerized tomography (CT) or computerized tomography angiography (CTA) scanning. CT scanning of your head uses X-ray beams to assemble a composite 3D look at your brain or evaluate the arteries in your neck and brain. CTA scanning uses X-rays similar to a standard CT scan but may also involve injection of a contrast material into a blood vessel. Unlike a carotid ultrasound, a CTA scan can evaluate blood vessels in the neck and head.
• Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). These procedures, which use a strong magnetic field, can generate a composite 3D view of your brain. MRA uses technology similar to MRI to evaluate the arteries in your neck and brain but may include an injection of a contrast material into a blood vessel.

• Echocardiography. Your doctor may choose to perform a traditional echocardiography called transthoracic echocardiogram (TTE). A TTE involves moving an instrument called a transducer across your chest. The transducer emits sound waves that bounce off different parts of your heart, creating an ultrasound image.

  Or your doctor may choose to perform another type of echocardiography called a transesophageal echocardiogram (TEE). During a TEE, a flexible probe with a transducer built into it is placed in your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, clearer, detailed ultrasound images can be created. This allows a better view of some things, such as blood clots, that might not be seen clearly in a traditional echocardiography exam.

• Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-ray imaging. A radiologist inserts a thin, flexible tube (catheter) through a small incision, usually in your groin.

  The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then the radiologist injects a dye through the catheter to provide X-ray images of the arteries in your brain. This procedure may be used in selected cases.