Transient ischaemic attack

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Target exams

Red flags

• A TIA is a medical emergency, not a diagnosis to reassure and discharge — the highest stroke risk sits in the first 48 hours, and urgent assessment plus treatment cuts the 90-day stroke risk by roughly 80 per cent
• Check the finger-prick glucose first — hypoglycaemia reproduces a focal deficit with complete fidelity and is reversed in minutes if caught
• If any focal deficit is still present on assessment it is NOT a TIA — manage on the acute stroke pathway for thrombolysis, because a deficit that persists is a stroke until imaging proves otherwise
• Amaurosis fugax with a carotid bruit and atrial fibrillation points to severe symptomatic carotid stenosis — the single most impactful intervention is carotid endarterectomy within two weeks, and every hour of delay shrinks the benefit
• Never thrombolyse a deficit that has fully resolved — by definition the deficit of a TIA has gone, and alteplase has no role once the episode is over
• A patient on an anticoagulant who has a definite TIA has failed that treatment — reassess the mechanism, check adherence and the last dose, and escalate; do not simply add an antiplatelet