History and exam

Key diagnostic factors

common

sudden onset and brief duration of symptoms (minutes)

A TIA may last anything from a few minutes to 24 hours. However, most patients usually have complete resolution of symptoms and signs within 1 hour.[2]

patient/witness report of focal neurological deficit

The key factor for a suspected diagnosis of TIA.

Other diagnostic factors

common

unilateral weakness or paralysis

Unilateral weakness or paralysis in the face, arm, or leg can occur with both anterior and posterior circulation TIAs.[43]

Bilateral limb weakness is a feature of vertebrobasilar (brainstem) ischaemia.[43]

dysphasia

Common in anterior circulation ischaemia.[43] Usually indicates left-sided cerebral hemisphere ischaemia.

ataxia, vertigo, or loss of balance

Common in posterior circulation TIAs.[44]

sudden transient loss of vision in one eye (amaurosis fugax)

Common in anterior circulation ischaemia and an early warning signal for cervical carotid stenosis.[43] Investigate cervical carotid stenosis urgently. See Carotid artery stenosis.

homonymous hemianopia

Common in posterior circulation TIAs if present in isolation.[44]

diplopia

Common in posterior circulation TIAs.[44]

risk factors

Consider key risk factors for TIA:

  • Cardiovascular disease

    • Atrial fibrillation[17][19] 

    • Valvular heart disease[19] 

    • Carotid stenosis[20] 

    • Congestive heart failure[19]

    • Hypertension[17][19]

  • Diabetes mellitus[17][19][26] 

  • Hyperlipidaemia[49]

  • Other significant illnesses such as a hypercoagulable state or vasculitis (e.g., temporal arteritis)[8]

  • Cigarette smoking[17][27]

  • Alcohol-use disorder.[50][51] 

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