What is the role of medical history in the evaluation of suspected transient ischemic attack (TIA)?

Updated: Dec 03, 2018
  • Author: Ashish Nanda, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Answer

Carefully investigate the onset, duration, fluctuation, and intensity of symptoms. Reviewing the patient's medical record is extremely important for identifying deficits from previous strokes, seizures, or cardiac events. The primary care physician can be a reliable resource for insights into previous episodes and workup.

Use these various resources to attempt to clarify when symptoms first occurred, how long they lasted, whether the patient recovered completely (ie, returned to baseline status), and if a pattern of escalating symptoms is present. For patients who woke up or are found with symptoms, the time they were last known to be normal should be documented.

If a patient has a history of associated trauma or cardiac symptoms, the differential diagnosis widens. Pertinent negative items (eg, lack of headache, lack of chest pain, and lack of eye pain) in the review of systems are also important.

Carotid or vertebral dissection can occur in association with both major and minor trauma. The patient may provide a history of blunt or torsion injury to the neck. An apparent association between cervical manipulation (as in chiropractic neck adjustment or massage therapy) and arterial dissections has been frequently reported. [17, 18]


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