Differential diagnosis

The differential diagnosis of a TIA includes:

• migraine:
  • one third of TIA's are accompanied by headache
  • migraine is associated with positive symptoms and frequently involve the visual system
  • symptoms of TIA arise swiftly, affect several parts of the body simultaneously, and peak in seconds to minutes
    
    
• epilepsy:
  • focal epileptic seizures usually cause 'positive' phenomena e.g. rapid march of symptoms up the arm or leg
  • confusion between focal motor seizures and TIA's tend to arise when post-ictal weakness (Todd's paresis) is emphasised rather than jerking, or the seizure is an inhibitory type
    
    
• structural brain lesions:
  • tumours
  • chronic subdural haematomas
  • vascular malformation
    
    
• other non-vascular causes:
  • multiple sclerosis
  • Meniere's disease
  • hypoglycaemia
  • hysteria (1,2)
    
    
• in patients with transient monocular symptoms:
  • giant cell arteritis
  • malignant hypertension
  • glaucoma
  • papilloedema
    
    
• transient global amnesia (1)

Reference:

• (1) Solenski NJ. Transient Ischemic Attacks: Part I. Diagnosis and Evaluation. AAFP 2004;69:1665-74,1679 2
• (2) Edlow JE. Current Controversies in the Management of TIA. ACEP Scientific Assembly.