TIA and stroke: a guide from a consultant geriatrician

If stroke symptoms are happening now, call 999. Face drooping, arm or leg weakness, slurred or muddled speech, sudden loss of vision or sudden severe unsteadiness are an emergency even if they seem to be improving. Do not book an appointment, do not wait to see if they pass and do not drive yourself to hospital.

If the symptoms came and went (a possible TIA), NHS advice is still to call 999, even though the symptoms have gone. National guidance (NICE) is that people with a suspected TIA are started on aspirin unless there is a reason not to, and are seen by a stroke specialist within 24 hours of the symptoms starting.

Written and reviewed by Dr Pravin Jha, Consultant Geriatrician & Specialist Physician (MBBS, MD, DM, DGM, FRCP, MBA). Last reviewed: 28 September 2026.

A transient ischaemic attack (TIA) is a brief interruption of the blood supply to part of the brain that causes stroke-like symptoms which resolve completely. It is a warning: the risk of a stroke is highest in the days that follow, which is why it is treated as urgent. I am a consultant geriatrician and specialist physician, and I wrote this guide for people who have had a TIA or a stroke and for their families: what the tests show, what else it could have been, driving, recovery and prevention.

In this guide:

Getting a diagnosis

Is a TIA a serious stroke?

A TIA is not a stroke, but it is serious. In a TIA the symptoms go away and brain scanning shows no lasting damage; in a stroke part of the brain is injured. The old rule that a TIA lasts less than 24 hours is no longer how the two are separated: if a scan shows a small area of damage, the event is treated as a minor stroke even when the person has recovered fully. Either way, the risk of a further stroke is highest in the first days, and prompt assessment and treatment reduce it.

Does a TIA show up on an MRI or CT scan?

Often it does not, and a normal scan does not rule a TIA out. The diagnosis rests mainly on an accurate account of what happened. MRI with diffusion-weighted imaging is the most sensitive test: it shows a small recent area of damage in a proportion of people whose symptoms resolved, and it can show another cause of the symptoms. NICE advises that, when MRI is done, it is done on the day of the specialist assessment. A CT scan is usually normal after a TIA and is not needed routinely; it is used when another cause, such as bleeding, is suspected.

Is there a test to check for a TIA? Can a blood test show it?

No blood test confirms or excludes a TIA. Blood tests look for causes and risk factors (cholesterol, diabetes, blood count, kidney function) and for conditions that can imitate a TIA, such as a low blood sugar. The other standard investigations are an ECG and heart rhythm monitoring for atrial fibrillation, and an ultrasound scan of the carotid arteries in the neck.

What can be mistaken for a TIA?

Many episodes that look like a TIA turn out to have another cause, and getting this right matters because the treatment is different. The common mimics I see in older people are:

  • migraine aura, which can occur for the first time in later life, often without a headache;
  • fainting and near-fainting from a fall in blood pressure on standing, heart rhythm problems or medication;
  • a focal seizure, which can cause brief weakness or confusion;
  • transient global amnesia, a sudden episode of memory loss lasting hours that resolves fully;
  • a low blood sugar in someone treated for diabetes;
  • inner-ear vertigo, where the room spins with head movement (see dizziness in older adults);
  • a subdural haematoma (a slow bleed on the surface of the brain), particularly after a fall or in someone taking anticoagulants;
  • anxiety and functional symptoms, which are real and treatable.

Sorting out transient episodes like these is a large part of my work. When a TIA has been ruled out, the question becomes what did cause the episode, and that usually needs a whole-person review of blood pressure, heart rhythm, medication, balance and memory rather than a single test. I describe how I do this in a TIA and stroke assessment and a comprehensive geriatric assessment.

Who treats a stroke: a neurologist, a cardiologist or a stroke physician?

In the UK, stroke care is led by stroke physicians, working in hyperacute stroke units and stroke wards. Stroke medicine is a specialty that doctors enter from geriatric medicine, neurology or general medicine. As a geriatrician I see older people after a TIA or stroke, particularly when frailty, memory problems, falls or several medicines complicate recovery and prevention. Neurologists see people with stroke-like symptoms that may have another neurological cause, and cardiologists become involved when the cause is in the heart, for example atrial fibrillation or a hole in the heart (patent foramen ovale).

Emergency treatment

Can a stroke in progress be stopped, and can stroke symptoms be reversed?

Only in hospital, and only if treatment starts quickly. Most strokes are caused by a blocked artery. For suitable patients, clot-busting medicine (thrombolysis) given within hours of the first symptom, or removal of the clot through a catheter (thrombectomy), can limit the damage and sometimes reverse the symptoms. These are the main hospital treatments, alongside aspirin or other medicine to prevent further clots once bleeding has been excluded. They are given in hyperacute stroke units after a brain scan has shown whether the stroke is caused by a clot or a bleed. There is nothing that stops a stroke at home, which is why the only right step is to call 999 at once.

What should I do if I have a stroke when I am alone?

Call 999 as soon as you notice symptoms, even if they seem mild or are fading. If you cannot speak clearly, stay on the line: the call can still be traced and help sent. If you can, unlock the front door and sit or lie somewhere you will not fall. Do not eat or drink, because a stroke can affect swallowing, and do not take aspirin before a scan, because some strokes are caused by bleeding. People who live alone may find a personal alarm or a daily check-in arrangement worthwhile.

Recovery, and whether it can get worse

How long do stroke symptoms last?

The symptoms of a TIA usually last minutes and resolve within an hour; by definition they resolve completely. After a stroke, recovery is fastest in the first weeks and months, when the brain is adapting and rehabilitation has most effect, and improvement can continue more slowly for a year or longer. Some effects, such as fatigue, can persist even when strength and speech have recovered well.

Can a stroke get worse over time?

Symptoms can worsen in the first hours and days, which is one reason for early hospital care. After that, the injury itself does not usually progress, but a further stroke, or several small ones, can cause new problems. Longer-term changes in mood, thinking and mobility are common after stroke and are often worsened by other illness, medication or reduced activity, so a new decline deserves assessment rather than being put down to the stroke. Memory and thinking problems after a stroke can be assessed in a memory assessment.

Outlook

What is the life expectancy after a stroke at the age of 90?

There is no single figure that applies to everyone. Outlook depends most on the type and size of the stroke, how well the person was managing beforehand, and other conditions such as heart failure, frailty or dementia. Many people in their nineties recover well from a minor stroke and return home; a large stroke at that age carries a much higher risk of death or long-term dependence. The stroke team can give a view on the individual, and a realistic conversation about priorities and future care is often helpful for families.

Living after a TIA or stroke

Do you have to declare a TIA or stroke to the DVLA, and when can you drive?

For car and motorcycle licences, the DVLA rules are that after a single TIA you must not drive for one month but need not notify the DVLA; after more than one TIA, you need one month off driving after each episode. After a stroke you must not drive for one month, and you may start again if you have made a satisfactory recovery; you must tell the DVLA if problems such as a visual field defect, weakness or difficulty with thinking remain after one month. Bus and lorry licence holders must stop driving and notify the DVLA. The rules are on GOV.UK: stroke and driving, and your stroke doctor can advise on your own situation.

Can you live a normal life after a stroke?

Many people do, especially after a TIA or a minor stroke. After a larger stroke, life often changes, and rehabilitation, adaptations at home and support for carers make a real difference. The Stroke Association provides information and local support for people with stroke and their families.

What should stroke patients avoid?

The most important things to avoid are those that raise the risk of another stroke: smoking, drinking more than recommended, uncontrolled blood pressure and stopping prescribed medication without advice. Tiredness is common after stroke, so pacing activity helps. Older people who have had a stroke have a higher risk of falls; a falls assessment looks at balance, blood pressure and medication together.

Does physiotherapy help after a stroke, including at home?

Yes. Physiotherapy, occupational therapy and speech and language therapy are the core of stroke rehabilitation. Much of it now takes place at home through NHS early supported discharge and community stroke teams. Regular practice between sessions matters as much as the sessions themselves.

Causes and prevention

What causes 85% of strokes?

About 85% of strokes are ischaemic, caused by a blocked artery; the rest are caused by bleeding in or around the brain. The blockage is usually a clot that forms on narrowed, furred arteries or travels from the heart, most often in atrial fibrillation. The main treatable risk factors are high blood pressure, atrial fibrillation, narrowing of the carotid arteries, diabetes, high cholesterol and smoking.

How is another stroke prevented after a TIA?

Prevention depends on the cause, which is why the investigations matter. It usually includes medicine to reduce clotting (antiplatelet medicine, or an anticoagulant if atrial fibrillation is found), a statin, good blood pressure control and, for some people with severe narrowing of a carotid artery, an operation to clear it. In older people the plan has to fit with their other conditions and medicines, for example balancing bleeding and falls risk against the benefit of an anticoagulant.

Arranging a specialist review

If symptoms are happening now, call 999; if they came and went and you have not yet been assessed, NHS advice is to call 999 even though they have stopped. Once the urgent NHS assessment has been done, I see people for a review of stroke prevention and medication, for transient episodes whose cause is still unclear, and for recovery after a stroke, including memory, mood, falls and frailty. No GP referral required. I see patients in clinic in Sheffield, at home within 50 miles of Sheffield, or by video. Details are on the TIA and stroke assessment, home visit and video consultation pages, fees are on the fees page, and you can contact me with questions.

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