Last reviewed: 16 Sep 2021
Last updated: 13 Jul 2020



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
  • 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

Treatment algorithm


Expert advisers

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust




MJ is an honorary senior lecturer at the University of Manchester.


MJ declares that he has no competing interests.

Rachael Power, MBChB, MRCP

Neurology Registrar

Manchester Centre for Clinical Neurosciences




RP has been sponsored by Novartis to attend the International Headache Conference.


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



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



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




KK has received travel grants for conferences/speaker honoraria from Bayer, Boehringer, Daiichi-Sankyo, Pfizer, and Shire.


Helena Delgado-Cohen,

Section Editor, BMJ Best Practice


HDC declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice


TAO declares that she has no competing interests.

Susan Mayor,

Lead Section Editor, BMJ Best Practice


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


JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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