Abstract Body

Transient neurological symptoms are due to acute ischaemia (TIA-Transient Ischaemic Attacks) or other non-ischaemic conditions (TIA mimics-migraine aura, focal seizure, amyloid spell, etc.). About 50% of patients with a suspected TIA/minor stroke have atypical TIA or TIA-mimic diagnosis. The evidence base for diagnosis of TIA is limited. Since acute ischaemic lesions on diffusion-weighted imaging are present in relatively few patients with a definite TIA, symptomatic diagnosis remains the mainstay of clinical practice. However, the widely accepted high level definition of a TIA as sudden onset, focal neurological deficit of presumed vascular origin lasting less than 24 hours provides no guidance on which symptoms are likely to be vascular in origin. It is crucial that patients with transient neurological symptoms have a correct diagnosis as it has fundamental implications for their investigation and treatment. Patients with isolated focal, negative non-progressive symptoms (non-consensus TIA) have a similar short and long-term risk of stroke as patients with classic-TIAs. Furthermore, non-consensus TIA patients have similar baseline investigation findings (atrial fibrillation, intracranial or extracranial vascular stenosis, patent foramen ovale, etc) as classic-TIAs. Although there is some evidence that non-specific transient neurological symptoms (transient neurological attacks) are associated with an increased risk of vascular events, there is still uncertainty about the risk of strokes after transient neurological symptoms that are non-focal or positive or progressive. The diagnosis of ischaemic and non-ischaemic transient neurological symptoms, their investigation and prognosis will be discussed.