What are the signs of a Transient Ischemic Attack (TIA)?

Signs of Transient Ischemic Attack (TIA)

The primary signs of a Transient Ischemic Attack (TIA) include transient, fluctuating, or persistent unilateral weakness (face, arm, and/or leg), speech/language disturbance, hemibody sensory symptoms, monocular vision loss, hemifield vision loss, and other focal neurological deficits that typically resolve within 24 hours. 1

Common Presentations of TIA

TIAs manifest with sudden-onset focal neurological deficits that vary based on the vascular territory affected:

• Motor symptoms: Unilateral weakness affecting face, arm, and/or leg 1
• Speech/language disturbances: Aphasia, dysarthria 1
• Sensory symptoms: Hemibody sensory loss or paresthesia 1
• Visual disturbances:
  • Monocular blindness (amaurosis fugax) 1, 2
  • Homonymous hemianopsia (visual field loss) 1
  • Binocular diplopia 1
• Posterior circulation symptoms:
  • Ataxia 1
  • Dizziness 1
  • Incoordination 1
  • Cranial nerve deficits 1
  • Dysarthria 1
  • Dysphagia 1

Risk Stratification Based on Symptoms

The risk of recurrent stroke after TIA varies based on symptom type and time since onset:

Very High Risk (symptom onset within 48 hours)

• Transient, fluctuating, or persistent unilateral weakness 1
• Transient, fluctuating, or persistent language/speech disturbance 1
• Fluctuating or persistent symptoms without motor weakness or speech disturbance 1

High Risk (symptom onset between 48 hours and 2 weeks)

• Transient, fluctuating, or persistent unilateral weakness 1
• Language/speech disturbance 1

Moderate Risk (symptom onset between 48 hours and 2 weeks)

• Hemibody sensory symptoms 1
• Monocular vision loss 1
• Binocular diplopia 1
• Hemifield vision loss 1
• Dysarthria, dysphagia, or ataxia 1

Lower Risk

• Symptoms presenting more than 2 weeks after onset 1
• Atypical sensory symptoms (patchy numbness/tingling) 1

Distinguishing TIA from Mimics

TIAs must be differentiated from conditions that mimic their presentation:

• Features more suggestive of true TIA:

  • Sudden onset of symptoms 3
  • Focal neurological deficit 3
  • Speech disturbance 3
  • Clear vascular territory involvement 4

• Features more suggestive of TIA mimics:

  • Nonspecific symptoms 3
  • Gradual onset 3
  • Patchy or non-anatomical distribution of symptoms 1, 4

Clinical Implications

• TIAs should be treated as medical emergencies due to high risk of subsequent stroke 2, 5
• The risk of stroke after TIA is highest in the first 48 hours, with estimated risks of 3.1% at 2 days and 5.2% at 7 days 1
• Among patients with multiple risk factors, the 7-day stroke risk can be as high as 36% 1
• Recent data shows lower recurrence rates with rapid access to TIA clinics: stroke recurrences at days 2,7,30,90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively 1

Public Awareness

• The FAST (face, arm, speech, time) message campaign is used in public education efforts 1
• One or more of face weakness, arm weakness, and speech difficulty symptoms are present in 88% of all strokes and TIAs 1
• Immediate activation of emergency medical services is crucial when TIA symptoms are recognized 1