Neglect is usually not encountered
in ‘true’ TIA probably because it is also determined by
clinical examination rather than being expressed as a
symptom. Features of posterior circulation TIA include
vertigo and/or diplopia, or loss of balance, or unilateral
weakness. In the context of sudden onset of visual symptoms,
it is important also to check for the presence of a
hemianopia from ischaemia of the visual cortex, and its
presence should alert the clinician to the possibility that a
stroke has occurred. Uncommonly, some patients with
chronic occlusion or near occlusion of the carotid artery
may complain of loss of vision in the presence of seeing
‘bright lights’ from retinal ischaemia, or give a history of
contralateral limb shaking mimicking seizures but
without epileptiform activity on electroencephalography.