Transient ischemic attack physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Goals of phyical examination

The goals of physical examination may include:

• To determine the underlying neurological deficit
• To assess the cardiovascular risk factors
• To establish thrombotic or embolic source of TIA

Physical examination

The sequence of physical examination in the patient suffering from transient ischemic attack is as follows:

Vital signs

Vital signs are essential component of initial physical assessment of patients with TIA:
Blood pressure

• Blood pressure assessment may help determine future risk of stroke.
• Blood pressure >140/90mm Hg adds a point to the ABCD2 score of future stroke assessment.

Pulse

• Irregularly irregular pulse may give a clue to underlying atrial fibrillation or valvular abnormality.
• Weak or feeble pulse need further cardiological assessment of patients with TIA.

Temperature

• Temperature may be normal or may increased indicating underlying infectious or inflammatory pathology.

Respiratory rate

• Abnormally increased or decreased respiratory rate may warrant underlying cardiac or pulmonary pathology.

Systemic review

To look for underlying risk factors responsible for TIA, a complete systemic examination is essential
Heart

• Surgical scar for previous cardiac surgery
• Abnormal heart rate and rhythm may point towards atrial fibrillation, valvular disease.
• Murmurs, rub or gallop may indicate underlying cardiac or valvular abnormalities

Neck

• Surgical scars for carotid endartectomy
• Aucultation of neck may reveal carotid bruit-carotid stenosis

Lung

• Signs of cardiac failure such as bilateral fine crepitations-Pulmonary edema

Skin

• Abnormal bruising or blueness of nails or skin may suggest underlying coagulopathy

Fundoscopy

• Retinal pigmentaion, plaques or signs indicative of uncontrolled hypertension or diabetes mellitus