GPAtlas🧭 When to suspect
Suspect a stroke or transient ischaemic attack (TIA) in any patient with the sudden onset of focal neurological symptoms. In primary care the single most useful distinction is the duration of those symptoms – not their severity. Use a validated screening tool such as FAST (Face, Arm, Speech, Time to call 999), and always exclude hypoglycaemia, the classic mimic, in every case.
The key safety message is that a TIA is not a benign event – it is a warning that carries a high early risk of a completed, disabling stroke. Both a stroke and a TIA are medical emergencies.
| Pattern | Defining feature | Immediate action |
|---|---|---|
| Stroke | Focal neurological symptoms still present (even if they began minutes ago) | 999 – immediate transfer to a hyperacute stroke unit |
| TIA | Focal symptoms have fully resolved (usually < 1 hour; by definition < 24 hours) | Aspirin 300 mg + specialist assessment within 24 hours |
Raise suspicion in older patients and in anyone with vascular risk factors – hypertension, diabetes, hyperlipidaemia, smoking, atrial fibrillation, or a previous stroke or TIA.
Source: NICE NG128 · National Clinical Guideline for Stroke
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