Transient ischemic attack with deceptive presentation

A patient with an initial diagnosis of TIA presented with a deceptive course of events and unfavorable outcome. Only a non-enhanced brain CT was performed initially. Hemodynamic studies were clone later on and revealed internal carotid artery (ICA) dissection on CT-angiography and evidence of irreversible ischemic changes on perfusion studies indicating that the ischemic process presumably was ongoing since the initial ischemic episode. Efforts to define patients with TIA with risk of developing major stroke are ongoing. We hereby exhort for more effort to include hemodynamic studies as early as possible in the radiological work-up of TIA.