GPAtlas🧭 When to suspect
A transient ischaemic attack is a transient episode of focal neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without acute infarction.
• Symptoms come on suddenly, are maximal at onset, and resolve completely – classically within minutes to an hour and, by definition, within 24 hours.
• True TIAs rarely last longer than an hour; the modern tissue-based definition rests on the absence of infarction on diffusion-weighted MRI.
The clinical importance is simple: a TIA is a warning of imminent stroke.
• The risk of stroke is highest in the first hours to days after the event.
• Urgent assessment with prompt secondary prevention substantially reduces that early risk.
• Every suspected TIA is therefore a medical emergency, even when the patient feels completely recovered.
Two skills matter in primary care:
• Recognise it (a sudden, focal, fully-resolved deficit) and act fast (aspirin plus urgent referral)
• Distinguish it from mimics – up to half of suspected TIAs prove to be something else – without ever letting that uncertainty delay referral
NICE advises against using ABCD2 or any risk score to decide urgency: treat every suspected TIA as high risk.
| Suggests TIA |
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• Sudden onset, maximal at the start, then complete resolution |
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• “Negative” deficits – loss of function: unilateral weakness or numbness, dysphasia |
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• Amaurosis fugax – a curtain descending over one eye |
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• Symptoms fitting a single vascular territory (carotid or vertebrobasilar) |
| Suggests a mimic – think again |
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• Gradual onset or a spreading “march” of symptoms (migraine) |
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• “Positive” phenomena – visual scintillations, limb jerking, spreading tingling (migraine or seizure) |
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• Isolated symptoms alone – dizziness, syncope or confusion in isolation are rarely a TIA |
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• Preceding aura or headache, or post-event confusion (migraine, seizure) |
Source: NICE NG128 · National Clinical Guideline for Stroke (UK and Ireland)
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