Tests and scans for transient ischaemic attack (TIA)

The diagnosis of TIA or minor stroke is normally made by a specialist on the basis of symptoms reported and a clinical examination. Some additional tests or scans will usually be undertaken to work out the cause of symptoms and the best treatment. These may include MRI (magnetic resonance imaging) or CT (computed tomography), scans of the head, blood pressure measurements, blood tests to check clotting, blood sugar and cholesterol levels, ECG (electrocardiogram) to look for an irregular heart rhythm, ultrasound (Doppler scan) of the carotid arteries to check for any narrowing reducing the blood flow. Sometimes an echocardiogram may be used to check for other forms of heart disease.
Most people had one or several of these tests. Many people knew the names of the tests and most had some idea about what they were testing for although sometimes if tests had been conducted whilst the person was still recovering from their TIA or minor stroke it could be difficult to remember the details.

Angus was called to the hospital soon after he had experienced two TIAs, and tests were…

Age at interview 61

Gender Male

Age at diagnosis 60

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I went to see my GP and he confirmed that I had a TIA, this was the first one I had. He then told me that I should go for further tests, and basically that was it with the doctor. I come back home, where I had a second TIA the next night, where I went partially blind in one eye, my right eye, it lasted for about 20 minutes, and this time rung the doctor immediately – not the hospital or an ambulance but the doctor – who confirmed that to come down and see him, which we did, confirmed that it was a second TIA. We then had a phone call from, the next day had a phone call from the hospital to immediately go up there, where we had various tests. I had MRI scans, ECG echocardiographs, you name it, all the tests that doctors do for your whole system, I had them all done. And basically that was how it stood even to now, because they found really nothing wrong with me to suggest that I’d have another one, or why I had one.

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Adrian had lots of tests and scans and attended an outpatient appointment with the TIA nurse…

Age at interview 53

Gender Male

Age at diagnosis 53

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And by the time they put the ECG on and done all the blood tests and give me the oxygen, by the time we left to get to the [hospital], I was three quarters of the way back, and feeling… odd rather than ill. I still felt like I had the goldfish bowl on my head, but by the time I got to the [hospital] I was fine.

They done all the tests, strength in the arms and the legs, and the speech, memory tests. And it all seemed to be fine.

I asked all the questions, where, what, how, why? They stopped me driving for a month, which was a real pain.

They answered all the questions, and when I went then, it was less than a week, before I had the first outpatients appointment.

And I met the TIA nurse and she went through everything. And explained the reason for the follow up, was that, just in case this is a precursor to something a lot worse. So I’ve had the brain scan, the neck scan, heart scan, everything. And it all seems to be fine. So there is no explanation. And there possibly never will be.

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Jennifer was admitted to hospital overnight and had a variety of tests and scans to check out…

Age at interview 55

Gender Female

Age at diagnosis 53

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When they got me up to the ward I was really, really tired. Very tired and I fell asleep right away and the doctor actually came at five o’clock in the morning to, to check me in. And they just wanted, that, that was a Thursday night I got admitted. And they kept me in till the Monday so, so they could get the scans all done and just generally check, check out to see what is, what it had been.

Slight, slight loss of power, power in my hand and, and my arm. It wasn’t as strong, strong as it usually is. Slight weakness in my, my leg. But I reckon about by 24 hours to 48 hours I was back, back to what I was previous to, to taking the TIA.

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People also recalled being asked questions to test their memory and understanding such as ‘Who is the prime minister?’ ‘What date is it?’ or being asked to recall their address or do simple maths.

Keith underwent a series of tests including questions to test his memory and understanding

Age at interview 58

Gender Male

Age at diagnosis 58

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When the ambulance or paramedics were here, did they do any tests here before you went to the hospital?

I seem to remember they did but again I can’t think it was a blood test. But I, I can’t remember. Certainly they asked me a series of questions very carefully and methodically. But I’m afraid it was a bit hazy so I can’t, I can’t exactly remember. I think they may have taken a blood test but I’m not sure.

So when you were at hospital for the three hours initially on that evening, and they did some other tests
A series of tests.

..do you know what they are?

Blood pressure certainly. I can remember that. They certainly took blood again. And I think they measured it, you know, heart beat testing, regularity of heart beat, after that it seemed a variety of things. And, and they did explain it. To be fair to them, they explained it clearly at the time, but I think I was not clear thinking at the time certainly.

And then after that you were admitted for a few days. Was, during that time, what happened? What sort of, were you doing, had more tests and things

A vast series of tests, you know, and the support given was so impressive it, it was, again clearly, clearly, clearly explained to me and people obviously knew what they were doing. I thought, I’d hoped, again I was going to skip out of hospital as quickly as possible but a consultant came in and started, asked a series of questions, count, counting back from 100 in sevens, relatively easy stuff. But it foxed me at the time. And he also asked me the date, well, in my job I do know the dates of various things and I knew the dates that I’d been on, on holidays but I was completely lost with this and he just raised his hands as if to say he’d made his point. That the, the effect was still with me and I should stay in, in hospital and but then there was a whole raft of tests after that, MRI tests and others.

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Mike was advised to stay in hospital and have his tests done rather than wait for them to be done…

Age at interview 63

Gender Male

Age at diagnosis 53

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We went to see our GP who knew exactly why we were there. She had a fax from him and after about two minutes of being with her, she said, Right, you’re off to the, another hospital to a TIA clini, which we took ourselves off to and we went in there and saw the chap very quickly. And within five minutes I was having an MRI scan [clears throat] A, a few minutes after that we saw the consultant again and he said there had been a small bleed in the brain and that I’d had a stroke. And he said, If you want you can go home but you would, you’ll not be able to have the tests that we want to do on you. You’ll have to, you’ll have to book up, book up for them and wait, wait, it could take weeks. So I suggest that you do come in and we do it much more quickly

So I said, Well, if I’m having a stroke then I ought, I ought to be, be here under some sort of contro. So I did that.

I was in for a week having, well having all these tests that he’d been promising me and the team were absolutely magnificent. What the one I remember, it was a while ago now, but I remember the young chap every morning he’d come in, always before breakfast and say, What’s your name? Where do you live? Where are you? Can you say British constitution’ And of course when, at the start of all this I didn’t say anything at all, I didn’t make sense of it but by the end of it I kept, kept saying yes, and it was all, all good practice. And for some while afterwards I’d try and say these things which improved my speech, although it’s not perfect now. it’s miles, hugely improved. Hugely improved. And now I’m just, I’m more, more or less, more or less living a normal life and perfectly, perfectly happy.

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There are standard questions that doctors use to identify whether memory parts of the brain are affected.

George was asked a series of questions to test his memory and how well he understood things, and…

Age at interview 77

Gender Male

Age at diagnosis 71

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One of the tests that I had at the hospital was, I was taking seven from a hundred was the one of the first thing, first thing they made me do. And keep on going until they said stop. I had to write a sentence think of as many words as I could beginning with the letter in that particular case, was the letter F. Reproduce a drawing. And then during the interim, interview they, they mentioned three words to me, for instance pear, apple and chair, just for argument’s sake. And I had to repeat those. And then a bit later on they through an interview they said to me. What were the three words I said to you And you had to try and remember what they were. I think I got two out of three right at that particular point. And, and that was more or less the extent of the tests they, they gave me, except as I say I had five MRI scans in the first six months and they kept an eye on me that way. And then at the Christmas the nurse came over here and she asked me exactly the same questions, everything was exactly the same and again in the summer exactly the same.

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Clare was still feeling disorientated when she was being asked questions by the consultant, and…

Age at interview 50

Gender Female

Age at diagnosis 48

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I don’t know what tests they were. Oh he’d, that’s right, he got, he, he’d started to, he started talking to me and I didn’t want to talk. I didn’t want to talk and I kept looking at my husband to answer for me. But he sort of like, No, I want to hear it from you So that’s when I, because I knew I still sounded like I was slurring and it was just sort of like really, really strange
You know, you’re slurring your words, what is happening? And then I just said to him, because he said about having a stroke, and I, and I can really remember turning round and just saying, But I’m just a baby, I’m only 48 And that was the real sort of like first time it was like, I’m 48. I’m 48

Is that what really hit home to you?

That hit home to me then. Why?

Why? You know, why? Why had I had a stroke? So then that was the next series of tests to find out why I had had a stroke. So he was just sort of he gave me, oh that’s right, he got me to do this with my hands
.. and I can remember feeling bloody irritated because I had to, he wanted me to do this and I can remember thinking, I just can’t do it with my left hand. I can do it with my right but it was like that with my left hand. It was really difficult. And then he told me to touch my nose with my left hand and I went to my chin and I thought, This is bizrdquo; it was bizarre experience because it’s like, you know, you don’t even think about it but having to do it and you miss and you think, That’s ridiculous So it was all very confusing.

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Blood pressure

High blood pressure is a major risk factor for strokes. If blood pressure readings show that the blood pressure is raised then further tests may be needed to check the body’s functioning, such as urine and blood testing and having an ECG. Doctors can then advise which blood pressure drugs are needed. (See Resources for more information)

Keith doesnt remember all the tests and scans he had at the time because he was feeling…

Age at interview 58

Gender Male

Age at diagnosis 58

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So when you were at hospital for the three hours initially on that evening, and they did some other tests
A series of tests.

..do you know what they are?

Blood pressure certainly. I can remember that. They certainly took blood again. And I think they measured it, you know, heart beat testing, regularity of heart beat, after that it seemed a variety of things. And, and they did explain it. To be fair to them, they explained it clearly at the time, but I think I was not clear thinking at the time certainly.

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John took part in a research study in which he had his blood pressure monitored and the results…

Age at interview 59

Gender Male

Age at diagnosis 58

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The GP explained that she, her practice was part of a group of practices associated with a research programme at the university, and I would get instant access to hospital, which was tremendous. And after the initial consultation, at the end of the consultation it was explained to me by the consultant I met that there was a research programme taking place, Would I be happy to take part in it And it was, the initial request was, Would I take my blood pressure three times a day and this would be sent in by mobile phone. Very happy to do that. And it’s been something which has, which has proved extremely useful, because that blood pressure is monitored and I’ve had telephone calls from the hospital suggesting that I change medication, as a result of the observation they see taken from those readings. So delighted with that. And I’ve also been involved in a research project at the university looking at developing new MRI techniques.

So very happy with those. And you feel, especially with the monitoring, you feel actually somebody’s there [laughs]. So you don’t have to rely on your own understanding of what’s happening. Somebody’s actually seeing genuine data coming in on a daily basis.

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Blood tests

Many of the people we spoke to returned to visit their GP, consultant, or stroke clinic for ‘check- ups’ at different intervals after the event, depending on their needs and circumstances. This might typically involve blood pressure checks, blood tests and monitoring medication (see ‘Monitoring and advice‘). Patients who are prescribed warfarin have to have their blood monitored regularly to ensure that the dose is correct.

Ken is on warfarin and has to have blood tests every week to monitor how things are going. Once…

Age at interview 68

Gender Male

Age at diagnosis 68

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I’ve had more blood tests [laugh]s heart checks the last three months than I’ve had in all my life.

with this warfarin test the palaver, I never thought I’d go be doing this for the rest of my life?

What was the testing for? What did that involve?

Well, yeah, first of all you had a blood test. Then you go and see a, a nurse and she takes all the details and she tells you all about it. And you now once a week I’ve been going to the hospital to have a blood test to see whether my blood clots are high or low, whether the tablets are going to change. You have to write everything down in the book, in the piece of paper. You have to tell them the change of everything, you know, change the medication, whether you bruise badly after the injection and things like that. it’s just so you’ve got that for the rest of your life. And then she said, All right, you can work up to one in three months But she said there’s not many people that get the three months. Eight weeks between one blood test to the next.

So how do you feel about the prospect of having to keep going through that all the time?

Not very happy about it, but if it means it’s going to keep me going, well, I’ve got to do it, you know. don’t like it, but got to do it.

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MRI scan

Many of the people we interviewed had one or several MRI scans at the hospital. Some had taken part in a research study and so may have had access to more than the standard tests (see ‘Taking part in TIA research‘).

John describes what it was like having an MRI scan

Age at interview 59

Gender Male

Age at diagnosis 58

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MRIs are a painless process. The only disturbing thing for some people, I suspect, is a fear of claus-, is anything to do with, around claustrophobia, because you are inserted into a tube. I’m pretty broad, and on the second occasion the tube actually was slightly squeezing my shoulders. You’re lying on your back on a wheeled carriage and the carriage is inserted into the tube. You’re, you have earplugs inserted in your ears, and you have earphones on, which allow the operators of the MRI to communicate with you. And you’re told in advance that there will be a series of noises. Those noises are very difficult to describe. They are loud and slightly disorientating. You feel nothing, absolutely nothing. So if you’re not claustrophobic, there is absolutely nothing to worry about. I don’t know what you do if you’re claustrophobic. I don’t know how you get past that. That’s a little mental challenge, to get past that. The first MRI I had lasted, I would suspect, 20 minutes. The second one, the research, was an hour and 20 minutes. And that’s quite a long time to be stuck inside a tube, lying still. But the resolution of the imagery coming out is extraordinary. So you’re, you’re happy that this instrument exists and you’re, you have access to it. So nothing to worry about in that sense.

Was the first one just bigger or more open in some way or ?

I think it was a modern instrument and it was slightly bigger.

I don’t know whether they’re getting bigger. But it was certainly, it seemed larger to me and it was better lit, it was warmer. It was a much cosier environment [laughs]. The second one was a research instrument, deep in the, the bowels of the hospital, and was there for research purposes, not to make patients feel at ease, I suspect.

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Electrocardiogram (ECG) and echocardiogram

ECGs detect heart rhythm changes such as an irregular heart beat due to atrial fibrillation which increases the risk of stroke (due to a potential build up of a blood clot inside the heart).This can be treated with medication such as warfarin which makes it more difficult for the blood to form clots.
Echocardiograms use ultrasound to detect how well the heart is pumping blood and to examine the pattern of blood flow through the heart. Occasionally blood can take a shortcut through a small hole in one of the heart walls, which can result in TIA and stroke and can be treated with anticoagulant medication or implanting a device to block the hole.

Carotid Ultrasound/Doppler Scan

This test uses ultrasound to measure blood flow in the carotid arteries, which are a major supply of blood to the brain. It can detect the presence of narrowing in the artery that might mean that surgery would be an appropriate treatment to reduce the chance of a future stroke.

Phil had an ultrasonic scan which showed that his arteries were blocked to some degree

Age at interview 72

Gender Male

Age at diagnosis 71

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Part of the diagnostics on the first afternoon included an ultrasonic scan. And the ultrasonic scan is a device that uses ultrasonics, very, very impressive technology, to measure the flow rate and to image the artery. And looking at the flow rate, they could see that there was some slight obstruction, it was about a 50 per cent obstruction, to my blood flow. Well, to me that’s a bit scary. That means only half the blood’s getting to the brain that should. And I think I need it all. And I wonder whether that’s a cause of some of this memory loss that people have, simply partial blockage. I’m sure this has been intensively researched. I haven’t looked into this. The thought just popped up right now. And the other part was that they could find that there was about a 40 per cent blockage on my left artery, and there was this 60 per cent furry blockage on my right artery. These furry blockages grow very quickly, and because it’s kind of furry they’re likely to be unstable and to have pieces, fragments that separate and they’re entrained in the bloodstream and into the capillaries of the brain. And so it was as a consequence of the ultrasonic scan. And in fact, looking at this now with hindsight and my picture, this is the magic diagnostic. Of course I’m only pointing at the carotid and I don’t know whether the other arteries have similar breakaways. But I wouldn’t have thought so, because – I’m not too sure on the physiology of this – but my understanding is that the carotid directly connects the heart, presumably comes off the aortic artery and then – so the only, it would either be a blockage in the aorta or – I think that’s the artery – or it would be a blockage in the carotid. So maybe all of these problems are caused by blockages in the carotid artery. And if this is the case, then to find out you just have to run this scan.

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