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Initial Work-Up for Suspected TIA The first step in evaluating a patient with symptoms of TIA is to confirm the diagnosis (Figure 1).
DIFFERENTIAL DIAGNOSIS The most common imitators of TIA are glucose derangement, migraine, seizure, postictal states, and tumors (especially with acute hemorrhage). TIA typically has a rapid onset, and maximal intensity usually is reached within minutes. Fleeting episodes lasting one or two seconds or nonspecific symptoms such as fatigue, light headedness (in the absence of other cerebellar or brain stem symptoms), and bilateral rhythmic shaking of the limbs are less likely presentations of acute cerebral ischemia. Distinguishing TIA from migraine aura can be difficult. Younger age, previous history of migraine (with or without aura), and associated headache, nausea, or photophobia are more suggestive of migraine than TIA. In general, migraine aura tends to have a marching quality; for example, symptoms such as tingling may progress from the fingers to the forearm to the face. Migraine aura also is more likely to have a more gradual onset and resolution, with a longer duration of symptoms than in a typical TIA.