TIA vs Stroke
How to tell TIA and Stroke apart when a board question makes them look alike.
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Persistent focal neurologic deficit at evaluation is the immediate branch toward acute stroke treatment.
Side by side
Transient focal neurologic deficit with complete clinical recovery and no acute infarct on diffusion imaging indicates TIA.
Persistent focal deficit or imaging-confirmed acute infarction indicates stroke and triggers reperfusion eligibility evaluation.
Brief arterial ischemia resolves before permanent tissue infarction occurs.
Sustained arterial occlusion causes irreversible brain ischemia and infarct core formation.
TIA often has normal noncontrast CT and no restricted diffusion on MRI; vascular imaging may still show high-grade carotid stenosis needing urgent secondary prevention.
Stroke may show early ischemic changes on CT and restricted diffusion on MRI within minutes; glucose should be checked immediately because severe hypo- or hyperglycemia can mimic deficits.
The trap
A common error is downgrading high-risk transient deficits as benign because symptoms improved. The resolving clue is vascular risk and timing: resolved deficits still require urgent antiplatelet and carotid or cardiac source evaluation.
The repair move
Next best step: obtain immediate noncontrast head CT to exclude hemorrhage and bedside glucose, then decide if deficits persist. If deficits persist and no contraindication exists, evaluate for IV alteplase within 4.5 hours and mechanical thrombectomy for large-vessel occlusion; if deficits resolved, start urgent secondary prevention with antiplatelet therapy and expedited etiologic workup.
Try a free question
CoreA 68-year-old woman has left facial droop and arm weakness for 90 minutes that are still present. CT head shows no hemorrhage. What is the next best step in management?
Show answer and explanation
Answer: A. Assess IV alteplase eligibility now. Persistent disabling deficits within the treatment window require immediate thrombolysis evaluation after hemorrhage exclusion.
Why the other choices are tempting
- B. Outpatient follow-up is unsafe with active deficits.
- C. Waiting for delayed MRI loses reperfusion opportunity.
- D. Routine heparin infusion is not standard acute ischemic stroke therapy.
- E. Symptomatic treatment alone ignores an ongoing ischemic emergency.
Flashcards
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What bedside feature most quickly separates TIA from completed stroke?
Whether focal neurologic deficits are still present on current exam.
What imaging finding supports TIA after symptom resolution?
No acute infarct on diffusion-weighted MRI.
Quick answers
What is the fastest way to tell TIA from Stroke?
Persistent focal neurologic deficit at evaluation is the immediate branch toward acute stroke treatment.
What is the key clue for TIA?
Transient focal neurologic deficit with complete clinical recovery and no acute infarct on diffusion imaging indicates TIA.
What is the key clue for Stroke?
Persistent focal deficit or imaging-confirmed acute infarction indicates stroke and triggers reperfusion eligibility evaluation.
What is the common trap with TIA vs Stroke?
A common error is downgrading high-risk transient deficits as benign because symptoms improved. The resolving clue is vascular risk and timing: resolved deficits still require urgent antiplatelet and carotid or cardiac source evaluation.