Transient Neurologic DeficitsAPPROACH

NEUROLOGIC · 19 SECTIONS

⚲

512 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Transient Neurologic Deficits Acute Aphasia And Speech Disturbance Acute Confusion And Delirium Postictal State And Seizure Recurrence Concern Seizure Acute Vision Loss New Tremor And Involuntary Movements Headache Vertigo Acute Weakness Or Numbness Gait Instability And Ataxia

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx78

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

02Alarm Features/alarm35

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

03Medications/meds30

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

04Diet/diet18

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

05Review of Systems/ros23

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

06Collateral History and Family History/chafh15

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

07Risk Factors/rf27

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

08Differential Diagnosis/ddx54

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

09Past Medical History/pmh19

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

10Physical Exam/exam36

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

11Lab Studies/labs16

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

12Imaging/img26

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

›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

13Special Tests/spec12

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

14ECG/ecg10

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

15Assessment/ax18

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

16Plan/plan45

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

17Disposition/dispo27

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

18Discharge Instructions/di13

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

19References/r10

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

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Transient Neurologic DeficitsAPPROACH

NEUROLOGIC · 19 SECTIONS

⚲

512 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx78

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

02Alarm Features/alarm35

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

03Medications/meds30

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

04Diet/diet18

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

05Review of Systems/ros23

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

06Collateral History and Family History/chafh15

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

07Risk Factors/rf27

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

08Differential Diagnosis/ddx54

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

09Past Medical History/pmh19

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

10Physical Exam/exam36

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

11Lab Studies/labs16

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

12Imaging/img26

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

›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

13Special Tests/spec12

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

14ECG/ecg10

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

15Assessment/ax18

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

16Plan/plan45

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

17Disposition/dispo27

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

18Discharge Instructions/di13

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

19References/r10

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

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.