Practice 10-Minute Consultation

Transient ischaemic attack

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.a2343 (Published 23 March 2009) Cite this as: BMJ 2009;338:a2343
  1. Vedamurthy Adhiyaman, consultant in geriatric medicine1,
  2. Sonja Adhiyaman, general practitioner 2
  1. 1Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ
  2. 2The Laurels Surgery, Flint, Flintshire CH6 5AF
  1. Correspondence to: V Adhiyaman adhiyamanv{at}yahoo.co.uk
  • Accepted 10 July 2007

A 64 year old man comes to your surgery five days after an episode of visual loss in his left eye, followed by right sided weakness and speech disturbance lasting 10 minutes. He has made a complete recovery and has driven himself to the surgery to ask whether he can return to work.

What issues you should cover

General points

  • Transient ischaemic attack (TIA) is a sudden onset focal neurological deficit that resolves completely within 24 hours.

  • Amaurosis fugax, an embolic form of a TIA in the carotid territory, is painless transient monocular blindness, described as a curtain, shade, or mist descending over the eye.

  • The diagnosis of a TIA is based entirely on history rather than brain imaging.

  • The risk of a recurrent event after a TIA is highest in the first month (risk of 8-10% at seven days and 11-15% at 30 days).

Assessing symptoms

Onset—Symptoms are sudden in TIA, as in acute stroke. Insidious onset of symptoms is unlikely to be a TIA.

Intensity— Symptoms of a TIA are maximal at onset. Gradual progression of symptoms would point to a different pathology, such as migraine, demyelination, or a tumour. Even though recurrent …

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