Emergency: requires immediate attention
Transient ischemic attacks
Alerts and Notices
Synopsis
The pathophysiology of TIAs is thought to be due to reversible episodes of focal brain ischemia caused by the same mechanisms as in acute ischemic stroke:
- Cardioembolic disease (commonly atrial fibrillation)
- Large vessel disease (commonly atherosclerotic disease of the carotid arteries or vertebrobasilar arteries)
- Small vessel disease (lacunar stroke syndromes commonly due to long-standing hypertension and diabetes)
Common symptoms include hemi-weakness of the face, hand, arm, or leg, hemi-sensation loss, aphasia, dysarthria, dysphagia, dizziness, diplopia, monocular vision loss, and difficulty walking. Findings fit within a specific vascular territory or stroke syndrome.
Certain populations, such as children, are less likely to be affected; however, TIA / stroke should be considered in young patients with Moyamoya disease, congenital heart disease, bacterial endocarditis, sickle cell anemia, mitochondrial disease, or homocystinuria. Patients taking oral contraceptives or estrogen may be at a higher risk at a younger age.
Related topics: drug-induced stroke, cerebral stroke, cerebellar stroke
Codes
ICD10CM:G45.9 – Transient cerebral ischemic attack, unspecified
SNOMEDCT:
266257000 – Transient ischemic attack
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential for a transient and reversible episode of focal neurologic symptoms can include:- Migraine headache – Often presents as a headache with slowly progressing neurologic dysfunction, whereas TIAs tend to present without headache.
- Seizure with Todd's paralysis – TIAs typically do not present with seizure.
- Carotid or vertebral dissection – These can be very painful, whereas TIAs tend not to be painful.
- Hypoglycemia
- Hyperglycemia
- Benign paroxysmal vertigo
- Drug effect
- Conversion disorder – Tend to have examinations inconsistent with neurologic dysfunction and symptoms that do not fit a specific vascular pattern.
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:03/19/2018
Last Updated:09/29/2021
Last Updated:09/29/2021
Emergency: requires immediate attention
Patient Information for Transient ischemic attacks
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