What immediate investigations should be performed for a patient presenting with symptoms suggestive of a TIA?

For a patient presenting with symptoms suggestive of a transient ischaemic attack (TIA), the immediate investigations and actions from a General Practice perspective include:

• Exclude Hypoglycaemia: It is crucial to exclude hypoglycaemia as the cause of sudden onset neurological symptoms ¹,².
• Immediate Referral for Specialist Assessment and Investigation: The patient should be referred immediately for specialist assessment and investigation, to be seen within 24 hours of symptom onset ¹,². This assessment will determine further specific investigations.
• Brain Imaging Considerations:
  • A computed tomography (CT) brain scan should generally not be offered to people with a suspected TIA unless there is a clinical suspicion of an alternative diagnosis that CT could detect ¹.
  • However, people with a bleeding disorder or those taking an anticoagulant should have an urgent CT scan to exclude haemorrhage ².
• Avoid Scoring Systems: Do not use scoring systems, such as ABCD2, to assess the risk of subsequent stroke or to inform the urgency of referral for people with suspected or confirmed TIA ¹,².
• Specialist Investigations (following referral): After specialist assessment, investigations such as MRI (including diffusion-weighted and blood-sensitive sequences) may be considered on the same day to determine the territory of ischaemia, detect haemorrhage, or identify alternative pathologies ¹. Urgent carotid imaging should also be performed for anyone considered a candidate for carotid endarterectomy after specialist assessment ¹.