Stroke Evaluation

Our Approach to Stroke Risk Assessment

Identify the warning. Map the risk. Prevent the major event.

A transient ischemic attack - often dismissed by patients as "just a funny spell" because symptoms resolve within minutes to hours - carries one of the highest short-term stroke risks of any medical presentation. Up to 1 in 5 patients who experience a TIA will go on to have a major stroke within 90 days if the underlying cause is not identified and treated, with the highest risk concentrated in the first 48 hours. This single fact underpins why prompt, assessment, recognising that the window for effective prevention is measured in hours and days, not weeks.

1. Rapid Clinical Assessment

• Detailed symptom history - precise characterisation of the neurological event, duration, and complete resolution pattern consistent with TIA versus evolving stroke
• ABCD2 scoring - a validated clinical tool estimating short-term stroke risk following TIA, directly guiding urgency of further investigation
• Comprehensive neurological examination - assessing for any residual deficit that might indicate established infarction rather than transient ischemia
• Cardiovascular examination - blood pressure, cardiac rhythm assessment, and carotid auscultation as part of the initial evaluation
• Same-day assessment pathway for any patient presenting with suspected TIA, recognising the time-critical nature of stroke prevention

2. Brain Imaging

• Urgent CT brain - excluding haemorrhage and identifying any evidence of acute or established infarction
• MRI brain with diffusion-weighted imaging - the most sensitive imaging technique for detecting acute small infarcts, often present even after apparently complete symptom resolution
• MR angiography or CT angiography - visualising the intracranial and extracranial vasculature for any significant stenosis or occlusion
• Identification of silent infarcts - previous undetected strokes that significantly inform overall risk assessment and management urgency

3. Carotid & Vascular Assessment

• Carotid doppler ultrasound - non-invasive assessment of carotid artery stenosis, a major modifiable cause of stroke and TIA
• Quantification of stenosis severity - directly determining whether carotid intervention (endarterectomy or stenting) is indicated
• Vertebral artery assessment for posterior circulation symptoms
• Transcranial Doppler studies for selected patients requiring detailed intracranial vascular flow assessment

4. Cardiac Evaluation
    
   A significant proportion of strokes originate from cardiac sources, making cardiac assessment essential:

• ECG - identifying atrial fibrillation, a major treatable cause of cardioembolic stroke
• Extended cardiac rhythm monitoring - Holter monitoring or longer-duration monitoring for paroxysmal atrial fibrillation not captured on a single ECG
• Echocardiography - transthoracic, and transoesophageal when indicated, identifying structural cardiac sources of embolism
• Coordinated cardiology referral for any significant cardiac finding requiring specific treatment

5. Comprehensive Stroke Risk Factor Screening

• Stroke risk factor screening - blood pressure, lipid profile, blood glucose, and HbA1c assessment identifying modifiable vascular risk factors
• Thrombophilia screening in selected younger patients without clear conventional risk factors
• Identification and optimisation of every modifiable risk factor - hypertension, diabetes, dyslipidaemia, smoking, and atrial fibrillation
• Structured risk factor management plan developed collaboratively with each patient, addressing their specific risk profile

6. Secondary Prevention & Long-Term Follow-Up

• Antiplatelet or anticoagulation therapy initiated promptly based on identified stroke mechanism
• Statin therapy for vascular risk reduction, regardless of baseline cholesterol level, following confirmed TIA or stroke
• Carotid endarterectomy or stenting referral for significant symptomatic carotid stenosis

Structured follow-up with our neurologist stroke specialist team, tracking risk factor control and any new symptoms as part of comprehensive Stroke Evaluation in Mumbai, Indiathorough stroke evaluation following any transient neurological symptom is so critical.

At Shree Hospitals, our approach to TIA and stroke risk assessment and carotid screening in Mumbai treats every transient neurological symptom with the urgency it deserves. Our neurologist stroke specialist team provides same-day comprehensive