Transient Ischemic Attack (TIA) Workup Algorithm
Note: This document provides a structured summary of the Transient Ischemic Attack (TIA) Workup Algorithm for educational and reference purposes. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines and local protocols.
Patient presents with transient neurological symptoms suggestive of ischemia (resolving within 24 hours, typically much shorter).
ABCs, vital signs, focused history (symptom description, onset, duration, resolution), physical exam, neurological exam (NIHSS if symptoms present), blood glucose, ECG.
Obtain non-contrast head CT promptly to rule out hemorrhage or other mimics. MRI (DWI) is preferred if available and not delayed, as it is more sensitive for acute ischemia.
Does imaging or clinical presentation strongly suggest a stroke mimic (e.g., seizure, migraine, hypoglycemia) or is it consistent with TIA?
Manage according to the identified mimic’s specific treatment protocol.
Calculate the ABCD2 score: Age ($\ge$ 60 = 1 pt), BP ($\ge$ 140/90 = 1 pt), Clinical features (unilateral weakness = 2 pt, speech disturbance w/o weakness = 1 pt), Duration ($\ge$ 60 min = 2 pt, 10-59 min = 1 pt), Diabetes = 1 pt.
ABCD2 score and time from symptom onset guide the decision for inpatient vs. urgent outpatient workup.
- High Risk (ABCD2 $\ge$ 4 or crescendo TIA or known carotid stenosis): Urgent evaluation/admission.
- Lower Risk (ABCD2 < 4): Urgent outpatient evaluation (within 24-48 hours).
Admit patient. Rapid workup including carotid imaging (CTA/MRA/Ultrasound), cardiac evaluation (ECG, Echo, Holter), labs (lipids, A1c), and neurology consultation.
Schedule urgent outpatient appointments for carotid imaging, cardiac evaluation, labs, and neurology follow-up.
Antiplatelet therapy (Aspirin, Clopidogrel, or dual therapy depending on cause/risk). Statin therapy. Blood pressure control. Diabetes management. Smoking cessation. Lifestyle modifications. Consider anticoagulation if indicated (e.g., AFib).
Regular follow-up with primary care and/or neurology to ensure risk factors are controlled and secondary prevention is optimized.
