Ischemic Stroke vs Transient Ischemic Attack
Ischemic Stroke and Transient Ischemic Attack are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Ischemic Stroke vs Transient Ischemic Attack at a glance
- Ischemic Stroke: Acute focal neurologic deficit from arterial occlusion causing brain infarction.
- Transient Ischemic Attack: Transient focal neurologic deficit from cerebral ischemia without infarction.
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Side-by-side comparison
| Feature | Ischemic Stroke | Transient Ischemic Attack |
|---|---|---|
| At a glance | Acute focal neurologic deficit from arterial occlusion causing brain infarction. | Transient focal neurologic deficit from cerebral ischemia without infarction. |
| Classic presentation | Sudden onset focal deficit referable to a single vascular territory; NIHSS quantifies severity (0-42).; Sudden, focal neurologic deficit: unilateral weakness, sensory loss, aphasia, dysarthria, gaze deviation, hemianopia, ataxia, vertigo; Symptoms maximal at onset (contrast with progressive course of tumor); Headache uncommon (more… | Amaurosis fugax ('curtain coming down over one eye') suggests retinal embolism from ipsilateral carotid stenosis.; Sudden focal deficit identical to ischemic stroke but resolving — unilateral weakness, sensory loss, aphasia, monocular vision loss (amaurosis fugax), diplopia, vertigo, ataxia; Duration usually <1 hour (most <15 min);… |
| Workup / key labs | Clinical syndrome of acute focal neurologic deficit with imaging evidence of infarction (CT hypodensity or MRI DWI restriction) and exclusion of hemorrhage.; Fingerstick glucose immediately (rule out hypoglycemia); CBC, platelets, PT/INR, PTT, BMP, troponin; Lipid panel, A1c — for secondary prevention; Pregnancy test in women of… | Transient focal neurologic symptoms with no imaging evidence of infarction. ABCD2 score (Age, BP, Clinical features, Duration, Diabetes) stratifies short-term stroke risk.; Fingerstick glucose, CBC, BMP, lipid panel, A1c, PT/INR; ECG (atrial fibrillation, recent MI) |
| Imaging | Non-contrast head CT within 20 min of arrival — excludes hemorrhage (essential before tPA); CT angiography head and neck — identifies large vessel occlusion candidates for thrombectomy; CT perfusion or MR diffusion/perfusion — quantifies core vs penumbra for extended-window thrombectomy (DAWN, DEFUSE-3); MRI with DWI — most sensitive… | MRI brain with DWI — most sensitive; up to one-third of clinical 'TIAs' show acute infarction (reclassified as stroke); CT or CTA head and neck — evaluates for stenosis and excludes hemorrhage; Carotid duplex if neck CTA not done; Transthoracic echo; transesophageal if cardioembolic source suspected and TTE non-diagnostic; Prolonged… |
| First-line treatment | tPA dosing — alteplase 0.9 mg/kg IV (max 90 mg), 10% as bolus over 1 min, remainder over 60 min, if within 4.5 h of last known well and no contraindications (NINDS, ECASS III); Tenecteplase 0.25 mg/kg IV bolus — increasingly used alternative, particularly with LVO bridging to thrombectomy; Mechanical thrombectomy for anterior… | Aspirin 325 mg loading dose, then 81 mg daily — start immediately; Dual antiplatelet therapy (aspirin + clopidogrel) for 21-90 days after high-risk TIA (ABCD2 ≥4) or minor stroke, then aspirin monotherapy (CHANCE, POINT, THALES); High-intensity statin: atorvastatin 80 mg or rosuvastatin 40 mg (SPARCL); Blood pressure control (long-term… |
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