Transient ischemic attack

Preliminary Diagnosis: Transient Ischemic Attack

I. What imaging technique is first-line for this diagnosis?

Non-contrast CT of the brain with CTA of the head and neck.

II. Describe the advantages and disadvantages of this technique for diagnosis of transient ischemic attack.

Advantages

• Relatively inexpensive, fast imaging modality.

• Highly specific for hemorrhage.

• CTA of the head and neck is able to qualitate and/or quantitate any significant plaque burden with great specificity and sensitivity compared with companion MRA.

Disadvantages

• Very non-specific for early signs of an ischemic insult or infarct.

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• Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

Non-contrast MR of the brain with diffusion-weighted sequences and MRA of the head and neck.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of transient ischemic attack.

Advantages

• More specific and sensitive in diagnosing transient ischemic attacks and/or infarcts than CT

• Better able than CT to detail which vascular territory is affected

• Able to quantitate location and amount of atherosclerotic disease and plaque burden.

Disadvantages

• Expensive

• Time-consuming

• May be subject to motion artifact which degrades image quality.

VI. What are the contraindications for the alternative imaging techniques?

Contraindicated in patients with non-MR compatible hardware.

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