Transient ischemic attacks in the elderly: diagnosis and treatment.

Transient ischemic attacks (TIAs) are the most reliable warning sign of impending stroke and are highly indicative of significant coronary artery disease. The history and physical examination may suggest the pathologic mechanism, an important clue to diagnosis and prognosis. Diagnostic testing is individualized but often includes ECG and cerebral contrast angiography. Exercise testing, echocardiography, ultrasound, CT, and/or MRI are sometimes indicated. The patient with recent TIAs may be hospitalized for acute management. Long-term treatment includes stroke risk factor modification, use of antiplatelet agents, and sometimes anticoagulant therapy. Selected older patients may be candidates for carotid endarterectomy.