Investigations
1st investigations to order
blood glucose
full blood count and platelet count
Test
To exclude other causes of sudden-onset neurological symptoms (e.g., infection).[2]
Result
usually normal
prothrombin time, INR, partial thromboplastin time
Test
To exclude coagulopathy. Usually ordered in patients with TIA when the neurological deficit persists at the time of presentation, in case thrombolytic therapy is being considered.[2]
Result
normal unless the patient is already on anticoagulation, or has liver disease or antiphospholipid antibodies
fasting lipid profile
Test
As a baseline measure and to evaluate for treatable atherosclerotic risk factors.[2]
Result
may be normal; may show hyperlipidaemia
serum electrolytes
Test
To exclude electrolyte disturbance as a cause of sudden-onset neurological symptoms.[2]
Result
usually normal
ECG
Test
Request an ECG in all patients with suspected TIA to evaluate for atrial fibrillation and other arrhythmias, and to rule out myocardial ischaemia.[40]
In people who would be eligible for secondary prevention treatment for atrial fibrillation or flutter:[40]
Perform prolonged ECG monitoring (at least 24 hours)
Consider prolonged sequential or continuous ECG monitoring with an external patch, wearable recorder, or implantable loop recorder in those in whom no other cause of stroke has been found, particularly if they have a pattern of cerebral ischaemia on brain imaging suggestive of cardioembolism.
Result
may be normal; may show atrial fibrillation or other arrhythmias or myocardial ischaemia
Investigations to consider
CT scan
Test
Request an urgent CT scan of the head in patients taking an anticoagulant or with a bleeding disorder to exclude haemorrhage.[40]
Do not use CT head scanning in patients with suspected TIA unless you suspect an alternative diagnosis that CT could detect or they are using anticoagulants.[9][40]
Result
usually normal; may show haemorrhage
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