Browse categories and answer follow-up questions to refine your symptom profile.
History
Symptom characterization
Transient neurologic deficit profile
Last known well time
Symptom onset time
Symptom duration
Complete resolution
Fluctuating or stuttering symptoms
Persistent deficit at evaluation
Symptom pattern
Negative symptoms
Positive symptoms
Maximal at onset
Gradual spread
OPQRST
Onset
Sudden
Gradual
Wake up symptoms
Provocation and palliation
Positional trigger
Exertional trigger
Valsalva trigger
Relief with glucose
Quality
Weakness
Numbness
Aphasia
Dysarthria
Visual loss
Diplopia
Vertigo
Region and radiation
Right sided
Left sided
Face
Arm
Leg
Single limb
Severity
Functional impairment
Gait impairment
Speech impairment
Timing
Single episode
Recurrent episodes
Crescendo episodes
Similar prior episodes
Associated symptoms
Neurologic associated symptoms
Headache
Neck pain
Seizure activity
Post event confusion
Incontinence
Tongue bite
Visual aura
Systemic associated symptoms
Fever
Chest pain
Palpitations
Syncope
Dyspnea
Hypoglycemia symptoms
Context and triggers
Circumstances
At rest
During sleep
During driving
During exertion
Preceding events
Recent infection
Recent dehydration
Recent surgery
Trauma
Prior baseline
Baseline neurologic function
Prior stroke deficits
Baseline gait
Baseline speech
Similar prior episodes
Prior TIA
Prior seizure
Prior migraine aura
Alarm Features
Immediate escalation triggers
Time critical stroke indicators
Persistent focal deficit
New aphasia
New hemianopia
New neglect
New ataxia with inability to walk
Suspected large vessel occlusion
Hemorrhage and dissection indicators
Thunderclap headache
Severe neck pain
New Horner syndrome
Severe vomiting with headache
Anticoagulation use with new neurologic symptoms
Vital sign danger thresholds
High risk physiology
Hypoxia
Hypotension
Hypoglycemia
Hyperthermia
Severe hypertension with encephalopathy features
High risk historical features
High risk symptom patterns
Crescendo TIAs
Recurrent stereotyped episodes
Symptoms during exertion with syncope
Symptoms after neck manipulation
High risk exam findings
High risk neurologic findings
Ongoing focal deficit
Altered mental status
Meningismus
Papilledema
Do not miss pathways
If persistent deficit
Stroke protocol activation
Thrombolysis and thrombectomy eligibility workflow
If suspicion for subarachnoid hemorrhage
Immediate noncontrast CT head
Further testing if CT negative and high suspicion
Medications
Current and recent medications
Antithrombotics
Aspirin
Clopidogrel
Ticagrelor
Warfarin
Apixaban
Rivaroxaban
Dabigatran
Edoxaban
Vasoactive and cardiovascular
Antihypertensives
Antiarrhythmics
Statins
Neurologic and endocrine
Antiseizure medications
Insulin
Sulfonylureas
Adherence and timing
Last dose timing
Anticoagulant last dose time
Antiplatelet last dose time
Recent medication changes
New anticoagulant start or stop
Recent missed doses
Medication contraindications and interactions
Antithrombotic contraindications
Active bleeding
Recent intracranial hemorrhage
Severe thrombocytopenia
Thrombolysis relevant exposures
DOAC within recent dosing window
Recent major surgery or trauma
Diet
Intake and hydration
Recent intake
Poor oral intake
Vomiting
Diarrhea
Dehydration indicators
Glycemic exposures
Skipped meals
Alcohol related fasting
Caffeine and stimulants
Stimulant exposure
Caffeine excess
Energy drink intake
Sympathomimetic supplements
Alcohol and substances
Alcohol exposure
Binge use
Withdrawal risk
Recreational substances
Cocaine
Methamphetamine
Review of Systems
Neurologic
Neurologic symptoms
Weakness
Numbness
Speech change
Vision change
Vertigo
Ataxia
Confusion
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Palpitations
Dyspnea
Syncope
Infectious and inflammatory
Systemic symptoms
Fever
Chills
Weight loss
Night sweats
Headache and neck
Headache and neck symptoms
Thunderclap headache
Neck pain
Photophobia
Jaw claudication
Collateral History and Family History
Collateral source
Witness history
Onset details reliability
Observed seizure activity
Last known well confirmation
Family history
Vascular and arrhythmic risk
Early stroke
Early myocardial infarction
Atrial fibrillation
Inherited disorders
Thrombophilia history
Hemiplegic migraine history
Social support reliability
Supervision and follow up reliability
Responsible adult at home
Access to urgent follow up
Medication access
Risk Factors
Vascular risk factors
Atherosclerotic risk
Hypertension (I10)
Diabetes mellitus (E11.9)
Hyperlipidemia (E78.5)
Smoking
Chronic kidney disease (N18.9)
Cardioembolic risk
Atrial fibrillation (I48.91)
Recent myocardial infarction (I21.9)
Heart failure (I50.9)
Valvular disease
Thrombosis and bleeding
Thrombosis risk
Active cancer (Z85.9)
Recent immobility
Pregnancy and postpartum
Bleeding risk modifiers
Anticoagulation
Thrombocytopenia
Liver disease
Dissection and vasculopathy
Cervical artery dissection risk
Recent neck trauma
Chiropractic manipulation
Connective tissue disorder features
Exposure risks
Tox and metabolic risks
Hypoglycemia risk therapy
Carbon monoxide exposure risk
Illicit stimulant exposure
Differential Diagnosis
Life threatening
Cerebrovascular emergencies
Acute ischemic stroke (I63.9)
Persistent deficit
Large vessel occlusion concern
Transient ischemic attack (G45.9)
Resolved focal deficit
High early stroke risk
Intracerebral hemorrhage (I61.9)
Anticoagulation exposure
Severe headache with deficit
Subarachnoid hemorrhage (I60.9)
Thunderclap headache
Meningismus
Cervical artery dissection (I77.74)
Neck pain
Horner syndrome
Critical metabolic and toxic
Hypoglycemia (E16.2)
Rapid improvement with glucose
Diaphoresis and tremor
Severe electrolyte disturbance
Severe hyponatremia
Severe hypercalcemia
Common
Common mimics
Focal seizure with postictal deficit (G40.909)
Positive motor activity
Post event confusion
Migraine with aura (G43.109)
Gradual symptom spread
Positive visual phenomena
Peripheral vertigo
Isolated spinning
No focal deficits
Functional neurologic disorder (F44.4)
Inconsistent exam
Nonanatomic pattern
Less common
Other neurologic and systemic causes
Transient global amnesia (G45.4)
Anterograde amnesia
No focal deficits
Multiple sclerosis relapse (G35)
Subacute progression
Prior demyelinating history
CNS infection
Fever
Meningismus
Brain tumor with seizure
Progressive symptoms
New seizure
Key distinguishing clues
Localization patterns
Monocular vision loss
Cortical signs
Brainstem signs
Pure sensory symptoms
Past Medical History
Relevant conditions
Prior cerebrovascular disease
Prior ischemic stroke
Prior TIA
Prior intracranial hemorrhage
Cardiovascular disease
Coronary artery disease (I25.10)
Heart failure (I50.9)
Atrial fibrillation (I48.91)
Metabolic disease
Diabetes mellitus (E11.9)
Thyroid disease
Procedures and devices
Procedures and devices
Carotid endarterectomy or stent
Mechanical heart valve
Pacemaker or ICD
Baseline function
Functional baseline
Baseline mobility
Baseline speech
Baseline cognition
Physical Exam
General and vitals
General status
Airway and breathing stability
Perfusion and shock signs
Fever
Vital sign interpretation
Blood pressure extremes
Hypoxia
Hypoglycemia bedside check
Neurologic exam
Focused neurologic exam
Level of consciousness
Speech and language
Cranial nerves
Motor strength
Sensory exam
Coordination
Gait
Neglect testing
Stroke scale elements
NIHSS components
Posterior circulation screen
Cardiovascular and vascular
Cardiovascular exam
Irregularly irregular rhythm
Murmur
Signs of heart failure
Vascular exam
Carotid bruit
Pulse asymmetry
New Horner syndrome features
Head and neck
Head and neck findings
Meningismus
Temporal artery tenderness
Neck trauma signs
Pitfalls
Mimic indicators
Inconsistent weakness pattern
Give way weakness
Distractible deficits
Lab Studies
Point of care
Immediate bedside tests
Glucose
Pregnancy test when relevant
Core labs
Stroke and mimic evaluation
CBC
Electrolytes
Creatinine
INR and aPTT when anticoagulated or thrombolysis pathway
Troponin
Secondary labs
Etiology and risk modification
Lipid panel
HbA1c
TSH when clinically indicated
Interpretation pitfalls
Common pitfalls
Normal labs do not exclude TIA
Glucose derangements can fully mimic focal deficit
Imaging
Scoring Systems
Risk stratification tools
ABCD2 score
Early stroke risk estimate
Limited discrimination in modern practice
Canadian TIA Score
Short term stroke risk stratification
Local protocol dependent thresholds
MRI
MRI brain diffusion weighted imaging
Tissue positive minor stroke despite transient symptoms
Highest sensitivity for acute ischemia compared with CT
Contraindications
Pacemaker or ICD compatibility issues
CT
Noncontrast CT head
Hemorrhage exclusion prior to antithrombotic escalation
Low sensitivity for early ischemia
CT angiography head and neck
Large vessel occlusion detection
Cervical artery dissection assessment
Contrast kidney injury risk context
Contrast allergy history
Ultrasound
Carotid duplex ultrasound
Carotid stenosis screening
Timing dependent on local pathway
POCUS adjuncts
Cardiac POCUS for gross dysfunction
Limited for embolic source definition
Special Tests
Cardioembolic source evaluation
Cardiac rhythm evaluation
Continuous telemetry when admitted or observed
Ambulatory monitoring for paroxysmal atrial fibrillation
Echocardiography
Transthoracic echocardiogram
Bubble study for right to left shunt when indicated
Neurologic mimic testing
Seizure evaluation
EEG when recurrent stereotyped events
Postictal features support seizure pathway
Headache red flag evaluation
Lumbar puncture pathway when subarachnoid hemorrhage concern and imaging nondiagnostic
Opening pressure context when intracranial hypertension concern
ECG
Rhythm and ischemia screening
ECG indications
Suspected TIA or stroke
Palpitations or syncope history
High risk findings
Atrial fibrillation
Acute ischemic changes
Prolonged QT with syncope risk
Serial monitoring
Rhythm capture strategy
Telemetry for suspected paroxysmal arrhythmia
Ambulatory monitor planning if discharged
Assessment
Syndrome and localization
Transient focal neurologic deficit
Likely vascular territory pattern
Cortical signs present or absent
Posterior circulation signs present or absent
Most likely category
High risk TIA (G45.9)
Minor ischemic stroke (I63.9)
Mimic likely
Risk stratification
Short term stroke risk
Crescendo episodes
Tissue positive MRI
Large artery stenosis on CTA or ultrasound
Atrial fibrillation detected
Complications and exclusions
Immediate exclusions
Intracranial hemorrhage
Subarachnoid hemorrhage
Dissection
Hypoglycemia
Plan
First 5 minutes
Immediate stabilization and parallel workup
Cardiac monitor
Pulse oximetry
Fingerstick glucose
IV access criteria
Persistent deficits
Hemodynamic instability
Stroke protocol activation if persistent deficit
Diagnostic sequencing
Imaging sequence
Noncontrast CT head if stroke or hemorrhage pathway
CTA head and neck if large vessel occlusion or dissection concern
MRI DWI when diagnosis uncertainty or tissue based risk stratification needed
Etiology evaluation
ECG
Telemetry or ambulatory rhythm plan
Carotid imaging plan
Antithrombotic therapy
Antiplatelet strategy after hemorrhage exclusion
Aspirin PO 160 mg to 325 mg loading dose
Aspirin PO 81 mg daily maintenance
Clopidogrel PO 300 mg loading dose local protocol dependent
Clopidogrel PO 75 mg daily maintenance
Short course dual antiplatelet therapy local protocol dependent
High risk TIA
Minor ischemic stroke
Typical duration 21 days in many pathways
Anticoagulation for atrial fibrillation
Initiation timing based on infarct size and hemorrhage risk
Specialist or local protocol dependent
Blood pressure and glucose
Physiologic targets
Avoid hypotension
Treat hypoglycemia immediately
Severe hypertension management aligned with stroke protocol when applicable
Secondary prevention initiation
Risk factor modification starts in ED when appropriate
High intensity statin consideration
Smoking cessation support referral
Diabetes optimization referral
Consultations
Specialty involvement
Neurology or stroke team
Vascular surgery for symptomatic carotid stenosis
Cardiology for suspected cardioembolic source
Reassessment loop
Serial reassessment
Repeat neuro exam
Repeat vitals
Symptom recurrence monitoring
Escalate if new deficit
Disposition
Admission and ICU criteria
ICU indications
Ongoing neurologic deterioration
Large vessel occlusion requiring intervention pathway
Hemodynamic instability
Inpatient admission indications
High risk TIA or minor stroke requiring urgent workup
Crescendo TIAs
New atrial fibrillation
Symptomatic carotid stenosis
Inability to complete urgent imaging or rhythm evaluation as outpatient
Observation and rapid clinic pathways
ED observation pathway candidates
Resolved symptoms
Normal initial imaging for hemorrhage
Reliable follow up within 24 to 72 hours local protocol dependent
Rapid TIA clinic pathway candidates
Low risk features
Stable exam
No high risk imaging findings
Discharge criteria
Safe discharge elements
Symptoms resolved and stable
Hemorrhage excluded when antithrombotics planned
Clear antithrombotic plan
Follow up arranged within defined timeframe
Return precautions understood
Transfer criteria
Higher level of care transfer
Thrombectomy capable center need
Advanced imaging unavailable locally when time critical
Discharge Instructions
Copy discharge instructions
Patient facing instructions
You had a brief episode of neurologic symptoms that can be a warning sign for stroke
Call emergency services right away if symptoms return
Take medications exactly as prescribed
Do not drive until cleared if you had fainting or seizure concern
Follow up within the arranged timeframe
Return to emergency department now for
Any new weakness or numbness on one side
Trouble speaking or understanding
Vision loss
Severe sudden headache
New trouble walking or severe dizziness
Chest pain or fainting
References
Guidelines and key evidence
Stroke and TIA guidance
American Heart Association and American Stroke Association acute ischemic stroke guideline 2019 with updates
American Heart Association and American Stroke Association secondary stroke prevention guideline 2021
Canadian Stroke Best Practices recommendations update most recent version local protocol dependent
Decision tools and trials
Canadian TIA Score derivation and validation studies
ABCD2 score derivation and validation studies
CHANCE trial dual antiplatelet after minor stroke or high risk TIA 2013
POINT trial dual antiplatelet after minor stroke or high risk TIA 2018
Project file reference
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.