1)      Bilateral vision loss (? Early brainstem infarction)

2)      Symptoms increasing duration, severity, frequency ie. crescendo TIAs (impending infarction)

3)      Symptoms lasting less than 180 mins (candidate for tissue-type plasminogen activator tPA – referral to a center with such facilities)

4)      Acute myocardial infarction (cardiac source of emboli, aortic dissection)

5)      New onset atrial fibrillation (referral for further management)

6)      Cardiac source for cranial emboli (referral for further management)

7)      Paralysis and dysplasia severe (onset of infarction rather than ischemia)

8)      Severe carotid artery stenosis (referral for carotid duplex ultrasonography and further evaluation, 70-99% occlusion require endarterectomy, )

9)      Severe headache, photophobia, stiff neck, fainting (exclude SAH)

10)    Fever (exclude SABE)

11)    Confusion, headache, seizures, rheumatologic diseases, sympathomimetic use (CNS vasculitis)

12)    Head, neck, jaw pain (carotid, vertebral dissection)

13)    Absence of traditional risk factors for atherosclerosis like age, hypertension, diabetes, smoking, hypercholesterolemia, low HDL levels (cryptogenic strokes)

14)    Hypercoagulable states (strokes, migraine, spontaneous abortions, pulmonary emboli, DVT, F/H of any of these – hematologist evaluation )

15)    High-risk TIA’s for stroke (TIAs with hemiparesis, speech/language deficits, duration > 10 min, age > 60 yrs, diabetes)

16)    Postpartum states and dehydration (venous thrombosis)

17)    TIA and fever (SABE)

18)    TIAs and confusion, headache, seizures, rheumatoid disease, sympathomimetic use (CNS vasculitis)

19)    Women of childbearing age, recurrent abortion (Antiphospholipid syndrome)

20)    Recent head injury (SDH)