A GP guide to brief neurological disturbances

Distinguishing symptoms as either ischaemic or non-ischaemic can be difficult on clinical grounds alone but is greatly aided by neurovascular imaging

Need to know:

  • Transient neurological attacks (TNA) in the elderly are analogous to chest pain and require prompt investigation and treatment to identify ischaemic aetiologies and minimise subsequent stroke risk.
  • Clinical acumen cannot reliably distinguish ischaemic from non-ischaemic TNA causes.
  • All patients with TNAs of potentially ischaemic aetiology require a comprehensive workup, including extra- and intracranial vascular imaging and MRI.
  • CT/CT angiography is readily accessible and provides strong prognostic information regarding future stroke risk, helping guide treatment decision-making.
  • MRI sensitively identifies infarction, including in TNA patients otherwise deemed low risk.

Transient neurological attacks (TNA) are common in the elderly and increase in frequency with age.1,2