Presentation of acute stroke and transient ischaemic attack

Patients with stroke or transient ischaemic attack (TIA) present in two ways—either the symptoms are ongoing, or the symptoms have resolved.

If the symptoms are ongoing, suspect acute stroke. Patients will have a focal neurological deficit (eg hemiparesis, language dysfunction, vision loss and/or brainstem signs) that has come on abruptly. The patient must be evaluated in hospital urgently, because the timing of treatment is critical. Send the patient by ambulance to an emergency department.

In contrast, suspect TIA in a patient whose symptoms have resolved by the time they present. Most TIAs are brief—more than 90% last less than 1 hour. The patient will report a transient episode of neurological dysfunction (eg language dysfunction, vision loss, hemiparesis).

Subarachnoid haemorrhage (SAH) presents as acute onset of severe headache or sudden loss of consciousness (see advice on assessment and treatment). Focal neurological symptoms and signs are uncommon. A patient with suspected SAH must be assessed urgently in hospital.