Transient Ischemic Attacks can be easily missed!

Transient ischemic attacks(TIAs) are common warning events for higher risk of developing future stroke.

Patients presenting with transient ischemic attacks should be carefully evaluated for cardiovascular and cerebrovascular risk factors, in an attempt to modify, eliminate, or to treat, if present.

But in many cases, TIAs may pass unnoticed, either by patients’ ignorance of symptoms, owing them to exhaustion, or because of failure of the caring physician to attribute the given symptoms to cerebrovascular ischemic event.

The classic presenting features of TIAs are those of focal neurological deficits, usually in the form of limb(s) paralysis, facial nerve palsy, or unilateral visual loss ( amaurosis fugax).

But in a significant number of patients, the story may be quite different, as a minority of patients present with the following symptoms:

Dizziness: usually overlooked 

Confusion: mistakenly attributed to drug side effects, hypotension, dementia, etc.

Loss of consciousness : confused with more frequent causes, like hypoglycemic coma 

Limb-shaking TIAS : mimicking focal motor seizure.

The key features that help in suspecting TIAs are:

History of repeated very short episodes (a matter of few minutes), with full spontaneous recovery.

The presense of identifiable risk factors : Diabetes, hypertension, smoking, dyslipidemia, valvular heart disease, and coronary artery disease.

Absence of associated symptoms or signs that may suggest alternative diagnosis.

So the message is:

TIAs may be quite challenging in terms of detection and differentiation from other causes of transient neurological symptoms, an issue that requires a low threshold of suspicion, given the high risk of developing stroke, occasionally fatal.