Table 1

Clinical features of transient ischaemic attack (TIA) and some common mimics

DemographicOlder age
Vascular risk factors
More common in men
Younger age
More common in women
Any ageAny age, often younger
More common in women
More common in women
Neurological symptomsNegative symptoms, usually maximal at onset: for example, numbness, weakness, visual loss. Transient diplopia and monocular visual loss are often due to TIA
Does not spread into other sensory modalities.
Alteration or loss of consciousness almost never occur
Positive, spreading symptoms at onset. Visual the most common. May be followed by negative symptoms in the same domain
Symptoms may evolve into another modality (eg, visual followed by somatosensory)
True alteration or loss of consciousness almost never occur, though there may be ‘confusion’ or muddled thinking
Positive symptoms including painful sensory disturbance, limb jerking, head turning, dystonic posturing, lip smacking.
Loss of awareness and amnesia for event unless simple partial seizures
Postictal negative symptoms (eg, Todd's paresis) may persist for days
Faint or light headed (presyncopal). Vision may darken, or hearing becomes muffled.
Loss of awareness
Isolated sensory symptoms common
TimingAbrupt onset, gradual offset (minutes). Usually total duration minutes, nearly always <1 h
Recur over days or weeks, usually not months or years.
Usually last 20–30 min, but may be much longer
Can recur over years or decades.
Usually less than 2 min.
Can recur over years
Seconds to less than a minute.
Can recur over years
Tend to be recurrent and stereotyped
Associated symptomsHeadaches may occur, usually during the attacksHeadache usually afterwards with migrainous features (nausea, vomiting, photophobia, phonophobia, mechanosensitivity)Tongue biting (especially lateral), incontinence, muscle pains, exhaustion or disorientation, headache followSweating, pallor, nausea, rapid recovery to full alertnessMay be preceded by emotional or psychosocial stressors