From the Guidelines
Transient ischemic attack (TIA) typically presents as a brief episode of neurological dysfunction caused by temporary cerebral ischemia without evidence of acute infarction, with symptoms usually resolving completely within 24 hours, most often within 1 hour 1. The usual presentation of TIA includes sudden onset of symptoms such as:
- Unilateral weakness or numbness
- Speech disturbances (aphasia or dysarthria)
- Visual disturbances (monocular blindness or hemianopia)
- Dizziness
- Ataxia These symptoms are a result of a temporary interruption in blood supply to the brain, with no permanent clinical deficit or demonstrated infarct on subsequent imaging 1. The risk of subsequent stroke is high, with 8.8% at 7 days and 11.6% at 90 days 1, making immediate evaluation and management essential to reduce the risk of a recurrent, possibly more serious, event 1. Initial management includes rapid neuroimaging, vascular imaging of the head and neck, cardiac evaluation, and laboratory tests, with treatment typically involving antiplatelet therapy, management of vascular risk factors, and consideration of carotid revascularization if significant stenosis is present 1. The urgency of evaluation is based on the understanding that the risk of subsequent stroke is highest in the first 48 hours after a TIA, making this a true neurological emergency 1.
From the Research
Presentation of Transient Ischemic Attack (TIA)
The usual presentation of a Transient Ischemic Attack (TIA) includes:
- Transient, sudden-onset focal neurological symptoms which usually completely and rapidly resolve by presentation 2
- Episodes of focal neurological dysfunction that are of sudden onset, with the deficit completely resolving within 24 hours, but the majority of TIA episodes last only 5 to 30 minutes 3
- Sudden onset of symptoms, with the symptoms being maximal at onset rather than progressing over a period 4
- Neurological symptoms such as disordered speech, aphasia, vertigo, unilateral arm paralysis, and crooked mouth 5
- Transient visual obscuration, sudden weakness of one arm or leg, loss of speech, and dizzy spells 6
Key Characteristics
Key characteristics of TIA include:
- Sudden onset of symptoms
- Focal neurological symptoms
- Symptoms resolve completely within 24 hours
- High risk of subsequent stroke, especially within 2-7 days after the TIA 4
Diagnostic Considerations
Diagnostic considerations for TIA include:
- Taking a careful history to determine the onset of symptoms 4
- Performing basic investigations such as simple laboratory work-up, extra- and transcranial doppler/duplex-ultrasonography, cardiological examination, and CT-scan 6
- Using the ABCD2 score to differentiate between high-risk TIAs and low-risk TIAs 4