Transient ischaemic attack
Summary
Definition
History and exam
Key diagnostic factors
- sudden onset and brief duration of symptoms (minutes)
- patient/witness report of focal neurological deficit
Other diagnostic factors
- unilateral weakness or paralysis
- dysphasia
- ataxia, vertigo, or loss of balance
- sudden transient loss of vision in one eye (amaurosis fugax)
- homonymous hemianopia
- diplopia
- risk factors
Risk factors
- atrial fibrillation
- valvular disease
- carotid stenosis
- intracranial stenosis
- congestive heart failure
- hypertension
- hyperlipidaemia
- diabetes mellitus
- cigarette smoking
- alcohol-use disorder
- advanced age
- patent foramen ovale (PFO)
- inactivity
- obesity
- hypercoagulability
Diagnostic investigations
1st investigations to order
- blood glucose
- full blood count and platelet count
- prothrombin time, INR, partial thromboplastin time
- fasting lipid profile
- serum electrolytes
- ECG
Investigations to consider
- CT scan
Treatment algorithm
suspected transient ischaemic attack
confirmed transient ischaemic attack
Contributors
Expert advisers
Matthew Jones, MD, FRCP
Consultant Neurologist
Manchester Centre for Clinical Neurosciences
Northern Care Alliance
Honorary Senior Lecturer
University of Manchester
Manchester
UK
Disclosures
MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of a MRCP revision course.
Rachael Power, MBChB, MRCP
Neurology Registrar
Manchester Centre for Clinical Neurosciences
Manchester
UK
Disclosures
RP has been sponsored by Novartis to attend the International Headache Conference.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
Jennifer Simpson, MD
Associate Assistant Professor
Department of Neurology
University of Colorado School of Medicine
Denver
CO
Disclosures: JS is a site investigator for the POINT trial.
Ethan Cumbler, MD
Associate Professor
Section of Hospital Medicine
Department of Internal Medicine
Division of Medicine
University of Colorado School of Medicine
Denver
CO
Disclosures: EC declares that he has no competing interests.
Peer reviewers
Kayvan Khadjooi, MD, FRCP, PGCertMedEd
Consultant in Stroke Medicine
Addenbrooke’s Hospital
Associate Lecturer
School of Clinical Medicine
University of Cambridge
Cambridge
UK
Disclosures
KK has received travel grants for conferences/speaker honoraria from Bayer, Boehringer, Daiichi-Sankyo, Pfizer, and Shire.
Editors
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
Disclosures
HDC declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Susan Mayor
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Stroke
- Hypoglycaemia
- Seizure with post-seizure (Todd's) paralysis
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