Clinical features of transient ischaemic attack (TIA) and some common mimics
| TIA | Migraine | Seizure | Syncope | Functional/anxiety | |
|---|---|---|---|---|---|
| Demographic | Older age Vascular risk factors More common in men | Younger age More common in women | Any age | Any age, often younger More common in women | Younger More common in women |
| Neurological symptoms | Negative 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 |
| Timing | Abrupt 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 symptoms | Headaches may occur, usually during the attacks | Headache usually afterwards with migrainous features (nausea, vomiting, photophobia, phonophobia, mechanosensitivity) | Tongue biting (especially lateral), incontinence, muscle pains, exhaustion or disorientation, headache follow | Sweating, pallor, nausea, rapid recovery to full alertness | May be preceded by emotional or psychosocial stressors Anxiety |