What are the most common symptoms of a Transient Ischemic Attack (TIA)?

Most Common Symptoms of Transient Ischemic Attack (TIA)

The most common symptoms of a Transient Ischemic Attack (TIA) include transient, fluctuating, or persistent unilateral weakness (face, arm, and/or leg), speech/language disturbance (aphasia or dysarthria), hemibody sensory symptoms, monocular vision loss, and hemifield vision loss. 1

Primary TIA Symptoms by Frequency

• Motor symptoms: Unilateral weakness affecting the face, arm, and/or leg is one of the most common and highest-risk TIA symptoms 2, 1
• Speech disturbances: Aphasia (language impairment) and dysarthria (speech difficulty) are frequently observed in TIA patients 1, 3
• Sensory symptoms: Hemibody sensory loss or paresthesia (numbness, tingling) on one side of the body 1, 4
• Visual disturbances: Monocular blindness (vision loss in one eye) and homonymous hemianopsia (loss of vision in the same half of both visual fields) 1, 5
• Posterior circulation symptoms: Ataxia, dizziness, incoordination, cranial nerve deficits, dysarthria, and dysphagia 1, 4

High-Risk Symptoms

TIA symptoms are categorized based on their association with stroke risk:

• Very high risk (symptom onset within 48 hours):

  • Transient, fluctuating, or persistent unilateral weakness 2
  • Transient, fluctuating, or persistent speech disturbance/aphasia 2

• High risk (symptom onset between 48 hours and 2 weeks):

  • Same symptoms as very high risk but occurring within this timeframe 2

Visual Symptoms in TIA

• Monocular vision loss (amaurosis fugax) is a significant TIA symptom representing retinal ischemia 5
• The risk of stroke following transient monocular blindness varies with the number of stroke risk factors present (1.8% with 0-1 risk factors, 12.3% with 2 risk factors, and 24.2% with 3-4 risk factors over 3 years) 2
• Visual symptoms alone can be the sole presentation of TIA and should prompt urgent evaluation 5

Clinical Recognition

• The American Heart Association recommends the FAST (Face, Arm, Speech, Time) campaign for public education on recognizing TIA symptoms 1
• One or more of face weakness, arm weakness, and speech difficulty are present in 88% of all strokes and TIAs 1
• TIA symptoms are typically sudden in onset with focal neurologic deficits, distinguishing them from mimics that often present with nonspecific symptoms or gradual onset 3

Atypical Presentations

• Nonfocal neurological events (transient global amnesia, acute confusion, syncope, isolated vertigo, nonrotational dizziness, bilateral weakness) have a less established relationship to carotid and vertebral artery disease 2
• Purely sensory symptoms may indicate radiculopathy, neuropathy, microvascular pathology, or lacunar stroke rather than TIA 2
• A small proportion of patients with critical carotid stenosis (70-90%) may present with memory, speech, and hearing difficulties due to hypoperfusion 2

Clinical Implications

• TIA symptoms typically resolve within 24 hours, but this does not diminish their significance as warning signs 6, 3
• The risk of stroke following TIA is highest within the first 48 hours, with a 7-day risk as high as 36% in patients with multiple risk factors 2
• Recent data shows lower recurrence rates with rapid access to TIA clinics: stroke recurrences at days 2,7,30,90, and 365 being 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively 2

Common Pitfalls in TIA Diagnosis

• Failing to recognize isolated visual disturbances as potential TIAs 5
• Dismissing resolved symptoms as insignificant (even resolved symptoms warrant urgent evaluation) 5
• Misattributing posterior circulation symptoms (dizziness, ataxia) to non-vascular causes 1, 4
• Not recognizing that TIA symptoms can vary based on the vascular territory affected (carotid vs. vertebrobasilar) 4