Pitfalls
The pitfalls when managing TIA are:
- Failing to diagnose a TIA
- Failing to diagnose a TIA can have serious consequences for the patient i.e. stroke.
- An accurate diagnosis needs a good history and an understanding of neurovascular anatomy.
- Mistakenly diagnosing a TIA
- It is important to recognise that non-focal signs are not typically a feature of TIAs. The table below highlights this:
| Typical features – Focal signs | Non TIA symptoms |
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Posterior circulation TIAs
The diagnosis of a posterior circulation TIA may be missed if the possibility is not considered.
Carotid artery dissection
Carotid artery dissection can present with either stroke or TIA symptoms.
It is an important cause to consider in patients younger than 50 years, and accounts for up to 25% of ischemic strokes in young and middle-aged patients.
The mean age for ischaemic stroke, secondary to internal carotid artery dissection from blunt traumatic injury, is even younger at 35-38 years old. Head or neck trauma, including manipulation by a chiropractor, is often a precipitating factor.
There is usually a history of ipsilateral head, face or neck pain.
The neck pain is usually sudden, severe and persistent. A partial Horner syndrome (ptosis with miosis but no anhydrosis), is present in 36-58% of patients. Typical cardiovascular risk factors may be absent.
If suspected, immediate investigation is needed, either CT angiography or MRA.
The neck pain is usually sudden, severe and persistent. A partial Horner syndrome (ptosis with miosis but no anhydrosis), is present in 36-58% of patients. Typical cardiovascular risk factors may be absent [14].