What should I do if I experience transient one-sided body weakness, possibly a transient ischemic attack (TIA)?

Transient One-Sided Body Weakness: Emergency Management

If you experience transient one-sided body weakness, you must immediately go to an emergency department with advanced stroke care capabilities—this is a medical emergency requiring evaluation within hours, not days, as you are at very high risk for a completed stroke. 1, 2

Why This Is an Emergency

• Unilateral weakness is classified as VERY HIGH RISK for stroke when symptoms occurred within the last 48 hours, with up to 10% risk of completed stroke within the first week and highest risk in the first 48 hours. 1, 2
• Recent data shows that even with rapid specialized care, stroke recurrence occurs in 1.5% of patients at 2 days and 2.1% at 7 days—but without urgent intervention, historical rates were 5-10 times higher. 1
• The combination of facial and body weakness has a 72% probability of representing stroke and requires emergent evaluation to preserve brain tissue and prevent permanent disability or death. 3

Immediate Actions (First 24 Hours)

Where to Go

• Go directly to an emergency department with on-site brain imaging and ideally access to acute stroke treatments (thrombolytics, endovascular therapy). 1, 2
• Do not wait for an outpatient appointment—same-day ED assessment is mandatory for symptoms within 48 hours. 1

Essential Urgent Testing

Brain and Vascular Imaging (within 24 hours):

• Urgent CT or MRI brain scan to differentiate ischemic stroke from hemorrhagic stroke and rule out stroke mimics like subdural hematoma or brain tumor. 1, 2
• CT angiography (CTA) or MR angiography (MRA) from aortic arch to vertex to visualize extracranial and intracranial circulation, identify carotid stenosis requiring urgent surgery, and determine stroke mechanism. 1, 2
• Carotid ultrasound is an alternative if CTA/MRA unavailable, but CTA is preferred for comprehensive vascular assessment. 1

Cardiac Evaluation:

• Electrocardiogram (ECG) without delay to identify atrial fibrillation or evidence of myocardial infarction. 1, 2
• Extended cardiac monitoring (24-48 hours minimum) should be considered if initial ECG is normal but cardioembolic source suspected. 1, 2

Laboratory Tests:

• Complete blood count, serum electrolytes, creatinine, coagulation studies (aPTT, INR), and immediate bedside glucose to rule out hypoglycemia as a stroke mimic. 1, 2, 3
• Fasting lipid profile for risk stratification. 1

Risk Stratification by Timing

Within 48 Hours (VERY HIGH RISK)

• Unilateral weakness (face, arm, or leg) within 48 hours = highest risk category. 1
• Requires immediate ED referral and completion of all imaging/testing within 24 hours. 1, 2

48 Hours to 2 Weeks (HIGH RISK)

• Still requires comprehensive evaluation by stroke specialist, ideally within 24 hours of healthcare contact. 1
• Cannot wait more than 2 weeks for specialist assessment. 1

Beyond 2 Weeks (MODERATE RISK)

• Less urgent but still requires neurologist evaluation within one month. 1

Critical Treatment Decisions

If Significant Carotid Stenosis Identified:

• Early carotid revascularization (endarterectomy or stenting) should be considered urgently to prevent recurrent stroke. 1, 2
• Extracranial vascular imaging is specifically recommended to identify patients needing this intervention. 1

Immediate Medical Therapy:

• Antiplatelet therapy should be initiated rapidly in non-cardioembolic TIA. 4
• Anticoagulation for cardioembolic sources like atrial fibrillation. 4
• Statin therapy, antihypertensive agents, and risk factor modification substantially reduce 90-day stroke risk when started immediately. 4

Common Pitfalls to Avoid

• Do not assume symptoms are "too mild" to warrant emergency evaluation—even brief, resolved symptoms carry 10% one-week stroke risk. 2, 3
• Do not delay imaging for laboratory results—brain imaging takes absolute priority. 3
• Do not wait for outpatient follow-up—only 53% of stroke patients currently use emergency services despite clear mortality benefit. 3
• Do not dismiss symptoms because they resolved—TIA is often ignored by patients/families because symptoms naturally subside, but this is precisely when intervention prevents completed stroke. 4

Special Considerations

• Patients with multiple risk factors can have up to 36% seven-day stroke risk after TIA, making rapid specialized assessment even more critical. 1
• The ABCD2 score (Age ≥60, Blood pressure ≥140/90, Clinical features of unilateral weakness [2 points] or speech disturbance [1 point], Duration ≥60 minutes, Diabetes) helps stratify risk—scores ≥4 indicate very high risk requiring hospitalization. 4, 5
• Hospitalization is recommended for first TIA within 24-48 hours, crescendo TIAs, symptom duration >1 hour, known atrial fibrillation, or hypercoagulable state. 1, 5