A transient ischemic attack is a short episode of stroke symptoms from reduced blood flow that resolves without lasting damage on brain imaging. It is a warning sign, since the risk of stroke is highest in the next days, so the workup must be fast.
Key symptoms
- Sudden weakness or numbness of the face, arm or leg on one side
- Trouble speaking or understanding
- Brief loss of vision in one eye
- Symptoms that go away within minutes to an hour
What you find on exam
- Full neurological exam, often normal by arrival
- Blood pressure and pulse rhythm
- Listen for carotid bruits and heart murmurs
Tests
- MRI brain with diffusion imaging
- CT or MR angiography or carotid ultrasound
- ECG and cardiac monitoring for atrial fibrillation
- Glucose, lipids, HbA1c and blood count
Treatment basics
- Aspirin plus clopidogrel for about 21 days after a high-risk TIA, then a single antiplatelet
- High-intensity statin and blood pressure control
- Anticoagulation if atrial fibrillation is found
- Carotid endarterectomy or stenting for severe narrowing
- Quit smoking, exercise and manage diabetes
Red flags
- Symptoms that return or do not resolve
- Several episodes in a short time
- Atrial fibrillation or severe carotid narrowing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.