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Transient ischemic attack (TIA)
A TIA is a transient focal neurological episode with no infarct on imaging, and it is an alarm: stroke risk peaks in the first 48 hours, so work-up and treatment are urgent, not outpatient.
Why it matters in the exam
Questions describe unilateral weakness or a speech disturbance that has resolved and ask for the next step: urgent imaging, carotid assessment, rhythm monitoring, and a time-limited dual antiplatelet regimen. Distractors are built on mimics (hypoglycaemia, migraine aura, seizure) and on the wrong duration of dual therapy. The ABCD2 score is asked to separate high from low risk, but it never replaces a full work-up in every patient.
Key points
- A TIA is a transient focal deficit without infarct on DWI; with an infarct it is a minor stroke.
- Stroke risk is concentrated in the first 48 hours, so the work-up is urgent and done within 24 hours.
- An ABCD2 score of 4 or more or an NIHSS of 3 or less justifies aspirin plus clopidogrel for 21 days.
- Symptomatic carotid stenosis of 70 to 99 percent is treated with surgery within 2 weeks.
- Atrial fibrillation requires oral anticoagulation; everyone gets a statin and risk-factor control.
Summary table
| Element | Finding or rule | Practical meaning |
|---|---|---|
| Tissue-based definition | Transient focal symptoms with no infarct on diffusion-weighted MRI (DWI) | If DWI shows an infarct it is a minor stroke, not a TIA, even when the symptoms have resolved |
| ABCD2 score | Age 60 or older (1), BP 140/90 or higher (1), unilateral weakness (2) or speech disturbance alone (1), duration 60 minutes or more (2) or 10 to 59 minutes (1), diabetes (1) | A score of 4 or more marks high risk and supports early dual therapy |
| Work-up within 24 hours | DWI MRI, neck and head vessel imaging (CTA or duplex), ECG and prolonged rhythm monitoring, lipid profile and HbA1c | The aim is a treatable mechanism: carotid stenosis or atrial fibrillation |
| Dual antiplatelet therapy | Aspirin plus clopidogrel (300 mg load, then 75 mg daily) started within 24 hours, for 21 days | After 21 days switch to a single agent, because continuing dual therapy adds bleeding without extra benefit |
| Symptomatic carotid stenosis | Stenosis of 70 to 99 percent on the symptomatic side | Endarterectomy preferably within 2 weeks of the event |
| Atrial fibrillation | Found on ECG or prolonged monitoring | Oral anticoagulation (a DOAC is preferred), not antiplatelet therapy |
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Sources
- AHA/ASA Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack, 2021 — Antithrombotic therapy and diagnostic evaluation
- AHA/ASA Scientific Statement: Definition and Evaluation of Transient Ischemic Attack, 2009 — Tissue-based definition
- ESO Guideline on Management of TIA, 2021 — Early secondary prevention
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.