Which imaging study is the initial test of choice to rule out intracranial hemorrhage in suspected TIA?

• A. CT scan of the head
• B. Carotid Doppler ultrasound
• C. MRI
• D. Echocardiography

Answer: (A)

Non-contrast CT scan of the head is the initial imaging test to quickly rule out intracranial hemorrhage in suspected TIA. It’s fast, widely available, and specifically designed to detect acute bleeding, which is critical before considering treatments like thrombolysis. A negative CT doesn’t rule out ischemia, but it does permit safer progression with additional evaluation for stroke etiology; MRI may be more sensitive for early ischemic changes, but it isn’t the first-line test in this scenario due to longer scan times and variable availability. Carotid Doppler assesses carotid artery disease, not bleeding, and echocardiography looks for cardiac sources of emboli—not hemorrhage—so they aren’t the initial study for ruling out bleeding.