AKT · Neurology/Stroke & vascular

Transient ischaemic attack (TIA)

Transient focal ischaemia without infarction

Overview

A transient episode of focal neurological dysfunction from ischaemia, classically resolving within 24 hours, WITHOUT acute infarction on imaging. A warning of high early stroke risk — it mandates urgent assessment and immediate antiplatelet.

Recognise

Sudden focal deficit (weakness, dysphasia, amaurosis fugax — "curtain" over one eye) that fully resolves
No persisting deficit; symptoms typically minutes to <1 hour
High early stroke risk — especially crescendo TIAs

Red flags

Crescendo TIAs (≥2 in a week) or TIA on anticoagulant → admit; AF; carotid stenosis

Differentials & how to tell them apart

Ischaemic strokepersisting deficit / infarction on imaging — TIA fully resolves

Focal seizurepositive symptoms (jerking), post-ictal phase

Migraine auragradual march of positive visual symptoms, headache follows

Hypoglycaemiacheck glucose; resolves with treatment

Investigations

Specialist assessment within 24h. MRI (more sensitive for small infarcts) to confirm; carotid Doppler (endarterectomy candidates), ECG (AF), bloods/lipids/glucose. (ABCD2 no longer used to triage in NICE.)

Management

Aspirin 300 mg immediately + urgent (≤24h) specialist TIA clinic review

1Give aspirin 300 mg immediately; refer for specialist assessment within 24 hours; advise not to drive.Gate: Crescendo TIA (≥2 in a week), or a TIA while already anticoagulated → ADMIT rather than outpatient clinic
2Secondary prevention: clopidogrel 75 mg + high-intensity statin; carotid endarterectomy if >50% symptomatic stenosis; anticoagulate if AF.

Aspirin 300 mg immediately — unless contraindicated, until specialist review

Clopidogrel 75 mg + atorvastatin — secondary prevention

DOAC — if AF

Key points

Amaurosis fugax (transient monocular visual loss) is a retinal TIA. The point of urgent review is that early stroke risk is high — treat the warning.

Monitor & prognosis

Recurrence; carotid/AF work-up; risk-factor control.

Treating the TIA substantially cuts subsequent stroke risk.

Source: NICE NG128 (stroke and TIA)