Transient focal neurologic symptoms (resolved)
Recommended: MRI Brain with DWI + MRA Head and Neck is the preferred imaging study for transient focal neurologic symptoms (resolved). MRI within 24-48h to identify acute infarct (occurs in ~30% of clinically transient cases).
Recommended study
MRI Brain with DWI + MRA Head and Neck
MRI within 24-48h to identify acute infarct (occurs in ~30% of clinically transient cases). Vessel imaging looks for surgical target.
If the default doesn't apply
MRI contraindicated or unavailable
CT
CT Head + CTA Head/Neck
IV contrast
Carotid stenosis suspected, contrast contraindicated
US
Carotid Doppler Ultrasound
No contrast
Watch-outs
Crescendo TIA or persistent symptoms
Treat as evolving stroke — admit, anticoagulate per protocol, image emergently.
Atrial fibrillation discovered
Add TTE / TEE for source-of-embolism work-up; initiate anticoagulation when secondary prevention indicated.
Pearls
- ABCD2 score helps stratify short-term stroke risk after TIA.
- MRI within 24h identifies infarct in ~30% of clinically transient cases, upgrading diagnosis to ischemic stroke.
- Posterior-circulation TIA (vertigo, ataxia, diplopia) is easy to miss — image the vessels.