Synopsis
Recognise a suspected transient ischaemic attack, start safe immediate treatment, and arrange rapid specialist assessment without false reassurance from symptom resolution or a risk score.
- A TIA is a transient focal neurological syndrome caused by cerebral, spinal or retinal ischaemia without acute infarction; the diagnosis remains clinical and retrospective rather than being proved by one normal scan.
- Sudden negative symptoms such as unilateral weakness, language disturbance or monocular visual loss fit better than gradually spreading positive tingling, flashing lights or jerking, although atypical presentations still need expert assessment.
- Treat suspected TIA as an urgent warning of stroke: give aspirin 300 mg immediately unless contraindicated and arrange specialist assessment within 24 hours under current NICE guidance.
Key red flags
Any neurological deficit still present, even if improving, requires emergency acute-stroke assessment and immediate brain imaging rather than a TIA clinic appointment.
Investigation priorities
Identify a rapidly reversible mimic during or immediately after the focal episode.
Management branches
A patient reports a sudden focal neurological or monocular visual deficit that has now completely resolved.
- Confirm that no deficit remains, record last-known-well and symptom chronology, check glucose and observations, and seek emergency help if symptoms recur during assessment.
- Give aspirin 300 mg immediately unless allergy, active bleeding, current anticoagulation or another important contraindication requires urgent specialist advice.
Key medicines
AspirinGive 300 mg orally once immediately for suspected TIA unless contraindicated, then continue 300 mg daily until specialist review under the local pathway.
ClopidogrelFor established long-term non-cardioembolic secondary prevention, 75 mg orally once daily is commonly selected after specialist confirmation; loading or dual therapy follows a stroke protocol.