Transient Neurological Attack
A Useful Concept?
- S. Claiborne Johnston, MD, PhD
- Author Affiliations: Neurovascular Service, Department of Neurology, University of California, San Francisco.
- Corresponding Author: S. Claiborne Johnston, MD, PhD, Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Ave, M-798, San Francisco, CA 94143-0114 (clay.johnston{at}ucsfmedctr.org).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- BRAIN
- CEREBROVASCULAR DISORDERS
- DEMENTIA
- DIAGNOSIS
- ISCHEMIC ATTACK, TRANSIENT
- NEUROLOGIC MANIFESTATIONS
Conceptually, transient ischemic attacks (TIAs) are identical to ischemic strokes except the symptoms resolve within 24 hours. The underlying causes of TIA and stroke are identical, and recommendations for diagnostic evaluation and treatment are similar.1 Transient ischemic attack and stroke are different, however, in another important way, distinct from symptom duration: ischemic stroke is relatively easy to diagnosis with certainty, but there is often disagreement about whether a given patient has had a TIA.
The diagnosis of TIA depends on the recollections of a patient who, by definition, is an impaired observer. Neurological deficits that constitute a possible TIA may obscure a patient's observation and recollection of the event. Even if symptoms are recalled perfectly, conditions that mimic TIA may be indistinguishable from an actual ischemic event. Syncope, seizure, migraine, peripheral vestibulopathy, and conversion can be impossible to differentiate from TIA. Consequently, even with 2 neurologists reviewing the same …
