Editing Transient ischemic attack (section)

== Signs and symptoms ==
Signs and symptoms of TIA are widely variable and can mimic other neurologic conditions, making the clinical context and physical exam crucial in ruling in or out the diagnosis. The most common presenting symptoms of TIA are focal neurologic deficits, which can include, but are not limited to:<ref name=NBK459143>{{cite book | vauthors = Panuganti KK, Tadi P, Lui K |chapter=Transient Ischemic Attack |year=2020 |title=StatPearls |publisher=StatPearls |pmid=29083778 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK459143/ }}</ref>
* [[Amaurosis fugax]] (painless, temporary loss of vision)
* One-sided [[FAST (stroke)|facial droop]]
* One-sided motor weakness
* [[Diplopia]] (double vision)
* [[Vertigo|Problems with balance and spatial orientation or dizziness]]
* Visual field deficits, such as [[homonymous hemianopsia]] or monocular blindness<ref name="Amarenco">{{cite journal | vauthors = Amarenco P | title = Transient Ischemic Attack | journal = The New England Journal of Medicine | volume = 382 | issue = 20 | pages = 1933–1941 | date = May 2020 | pmid = 32402163 | doi = 10.1056/NEJMcp1908837 | s2cid = 218635760 }}</ref>
* Sensory deficits in one or more limbs and of the face<ref name="Amarenco" />
* Loss of ability to understand or express speech ([[aphasia]])<ref name="Amarenco" />
* Difficulty with articulation of speech ([[dysarthria]])<ref name="Amarenco" />
* Unsteady gait<ref name="Amarenco" />
* Difficulties with swallowing ([[dysphagia]])<ref name="Amarenco" />

Numbness or weakness generally occur on the [[Contralateral|opposite side of the body]] from the affected hemisphere of the brain.

A detailed neurologic exam, including a thorough cranial nerve exam, is important to identify these findings and to differentiate them from mimickers of TIA. Symptoms such as unilateral weakness, amaurosis fugax, and double vision have higher odds of representing TIA compared to memory loss, headache, and blurred vision.<ref>{{cite journal | vauthors = Amort M, Fluri F, Schäfer J, Weisskopf F, Katan M, Burow A, Bucher HC, Bonati LH, Lyrer PA, Engelter ST | display-authors = 6 | title = Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome | journal = Cerebrovascular Diseases | volume = 32 | issue = 1 | pages = 57–64 | date = 2011 | pmid = 21613786 | doi = 10.1159/000327034 | s2cid = 43769238 | url = http://edoc.unibas.ch/28874/1/document%28103%29.pdf }}</ref> Below is a table of symptoms at presentation, and what percentage of the time they are seen in TIAs versus conditions that mimic TIA. In general, [[Focal neurologic signs|focal deficits]] make TIA more likely, but the absence of focal findings do not exclude the diagnosis and further evaluation may be warranted if clinical suspicion for TIA is high (see "Diagnosis" section below).<ref name="pmid23062043">{{cite journal | vauthors = Simmons BB, Cirignano B, Gadegbeku AB | title = Transient ischemic attack: Part I. Diagnosis and evaluation | journal = American Family Physician | volume = 86 | issue = 6 | pages = 521–526 | date = September 2012 | pmid = 23062043 | url = https://www.aafp.org/link_out?pmid=23062043 }}</ref>

===TIA vis-à-vis mimics===

{| class="wikitable"
! Symptoms<ref name=pmid23062043/>
! % TIA mimics<ref name=pmid23062043/>
! % TIAs<ref name=pmid23062043/>
|-
| Unilateral paresis
| 29.1
| 58
|-
| Memory loss/cognitive impairment
| 18 to 26
| 2 to 12
|-
| Headache
| 14.6 to 23
| 2 to 36
|-
| Blurred vision
| 21.8
| 5.2
|-
| [[Dysarthria]]
| 12.7
| 20.6
|-
| [[Hemianopsia]]
| 3.6
| 3.6
|-
| [[Amaurosis fugax|Transient monocular blindness]]
| 0
| 6
|-
| Diplopia
| 0
| 4.8
|}

Non-focal symptoms such as amnesia, confusion, incoordination of limbs, unusual [[visual cortex|cortical]] visual symptoms (such as isolated bilateral blindness or bilateral positive visual phenomena), headaches and transient loss of consciousness are usually not associated with TIA,<ref name="Amarenco" /> however patient assessment is still needed. Public awareness on the need to seek a medical assessment for these non-focal symptoms is also low, and can result in a delay by patients to seek treatment<ref>Butler, Sonia & Crowfoot, Gary & Quain, Debbie & Davey, Andrew & Magin, Parker & Maguire, Jane. (2017). "Opening the Door to Funny Turns: A Constructivist Thematic Analysis of Patient Narratives after TIA". ''Public Health Research''. 7. 62–72.</ref>

Symptoms of TIAs can last on the order of minutes to one–two hours, but occasionally may last for a longer period of time.<ref>{{Cite web |title=Transient Ischemic Attack |url=https://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/Transient-Ischemic-Attack-TIA_UCM_492003_SubHomePage.jsp |url-status=dead |access-date=2017-12-10 |archive-date=2019-01-13 |archive-url=https://web.archive.org/web/20190113203755/https://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/Transient-Ischemic-Attack-TIA_UCM_492003_SubHomePage.jsp }}</ref><ref name=pmid19423857/> TIA is defined as ischemic events in the brain that last less than 24 hours. Given the variation in duration of symptoms, this definition holds less significance.<ref name=pmid19423857/> A pooled study of 808 patients with TIAs from 10 hospitals showed that 60% lasted less than one hour, 71% lasted less than two hours, and 14% lasted greater than six hours.<ref>{{cite journal | vauthors = Shah SH, Saver JL, Kidwell CS, Albers GW, Rothwell PM, Ay H, Koroshetz WJ, Inatomi Y, Uchino M, Demchuk AM, Coutts SB, Purroy F, Alvarez-Sabin JS, Sander D, Sander K, Restrepo L, Wityk RJ, Marx JJ, Easton JD | year = 2007 | title = A multicenter pooled, patient-level data analysis of diffusion-weighted MRI in TIA patients | journal = Stroke | volume = 38 | issue = 2 | page = 463 |s2cid=78309677 }} in {{cite journal |title=Abstracts From the 2007 International Stroke Conference |journal=Stroke |date=February 2007 |volume=38 |issue=2 |pages=453–607 |doi=10.1161/str.38.2.453 |doi-access=free }}</ref> Importantly, patients with symptoms that last more than one hour are more likely to have permanent neurologic damage, making prompt diagnosis and treatment important to maximize recovery.<ref name=pmid19423857/>