Clinical Assessment

The acute diagnosis of TIA is based on clinical history. Witness accounts are useful, but may not be available.

If a patient still has neurological symptoms when they are seen in the ED, it is more probable that they have had a stroke.

Important points to establish from the history are:

• The time of symptom onset and the duration of symptoms
• Associated symptoms
• Past medical history of co-morbidities associated with increased risk for TIA and CVA
• Past medical history of possible causes of neurological deficit other than TIA e.g. malignancy

In order to differentiate from stroke mimics, it is important to ascertain the following:

• The symptoms are acute in onset
• Symptoms reach maximum intensity within seconds
• Symptoms all begin at the same time
• There may be single or multiple episodes

Learning bite

A typical TIA will present with risk factors for vascular disease and one of the following:

• Limb weakness as a presenting symptom
• Speech difficulty as a presenting symptom
• Transient monocular loss of vision
• The symptoms are focal
• The symptoms fit with a vascular territory of the brain.
• The symptoms are negative
• Loss of function, as opposed to conditions such as migraine, which produce positive symptoms, for example flashing lights or wavy lines.

TIA symptoms are characterised by a loss of function.