Questionnaire/history: TIA: - Sudden onset, focal neurological deficit which has completely resolved within 24 hours (mostly within 1 h) of onset and cannot be explained by another condition such as hypoglycaemia? - Focal neurological deficits: - Unilateral weakness or sensory loss? - Dysphasia? - Ataxia, vertigo or loss of balance? - Syncope? - Sudden transient loss of vision in one eye (amaurosis fugax), diplopia, or homonymous hemianopia? - Cranial nerve defects Stroke:- Sudden onset, focal neurological deficit which is ongoing or has persisted for longer than 24 hours and cannot be explained by another condition such as hypoglycaemia - Clinical features vary depending on causative mechanism and the area of the brain affected: - Confusion, altered level of consciousness and coma? - Headache? - Insidious onset and gradually increasing intensity (?intracranial haemorrhage)? - Sudden, severe headache which may be associated with neck stiffness and sentinel headache(s) in the preceding weeks (subarachnoid haemorrhage)? - Unilateral weakness or paralysis in the face, arm, or leg? - Sensory loss — paraesthesia or numbness? - Ataxia? - Dysphasia? - Dysarthria? - Visual disturbance — homonymous hemianopia, diplopia? - Gaze paresis — this is often horizontal and unidirectional? - Photophobia? - Dizziness, vertigo, or loss of balance (isolated dizziness is not usually a symptom of TIA)? - Nausea and/or vomiting? - Cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis)? - Difficulty with fine motor coordination and gait? - Neck or facial pain (associated with arterial dissection)? - Acute, persistent, continuous vertigo or dizziness with nystagmus, nausea or vomiting, head motion intolerance and new gait unsteadiness (?acute vestibular syndrome) (?posterior circulation strokes)? Management Reference(s): NICE CKS: Stroke and TIA