MRIs of sudden onset monosymptomatic non-consensus TIAs in eight different patients with a causative ischaemic lesion
(A) Two patients with transient isolated dysarthria. (i) 59-year-old patient who had 30 s episode of slurred speech; examination normal; MRI shows restricted diffusion in right post-central gyrus; MRA normal; grade 2 shunt on bubble TCD. (ii) 64-year-old patient who had sudden onset isolated slurred speech for 12 h, which fully resolved; examination normal next day; MRI shows restricted diffusion in left parietal cortex; MRA normal; grade 2 shunt on bubble TCD. (B) Two patients with transient isolated vertigo or ataxia. (iii) 65-year-old patient with sudden onset isolated vertigo, which lasted 3 min; several recurrences over next few hours; examination showed nystagmus on left lateral gaze; CT brain scan in emergency department was normal; all symptoms resolved after 6·5 h; no hearing loss or tinnitus, but reported episodes of isolated unsteadiness lasting a few seconds, occurring daily for several weeks; MRI shows partial right PICA territory infarct, with tight stenosis of the proximal right vertebral artery on MRA. (iv) 45-year-old patient, heavy smoker, with sudden onset of rotatory vertigo and nausea lasting 12 h; examination normal the following day; MRI shows restricted diffusion in right cerebellum; MRA was normal. (C) Two patients with transient isolated double vision. (v) 64-year-old patient with sudden onset of double vision lasting 30 min; could see normally if covered either eye; saw an optician the following day and no abnormalities were detected; MRI shows restricted diffusion in right thalamus; MRA normal; grade 2 shunt on bubble TCD. (vi) 58-year-old patient woke up with diplopia, with one image diagonally above the other, which resolved on closing either eye; lasted 90 min but had mild headache for 24 h; past history of anxiety and migraine; examination normal; MRI shows restricted diffusion in right thalamus. (D) Two patients with transient isolated bilateral visual disturbance. (vii) 61-year-old patient with sudden onset blurring of the whole visual field; vision was not double; symptoms fully resolved after 30 min; examination normal; MRI shows restricted diffusion in right thalamus; MRA normal; grade 2 shunt on bubble TCD. (viii) 74-year-old with sudden onset blurring of whole visual field lasting 15 min; examination normal; MRI shows bilateral restricted diffusion in occipital lobes (arrows); CT angiography showed bilateral vertebral artery stenosis. MRA=magnetic resonance angiography. TCD=transcranial doppler. PICA=posterior inferior cerebellar artery.