A 70-year-old hypertensive man presents with sudden-onset right hemiplegia and aphasia lasting 3 hours, which then completely resolved. CT head is normal. MRI DWI shows no infarct. What is the most likely diagnosis and the single most important risk-reduction intervention?

• A Completed ischemic stroke; start warfarin
• B Todd's paralysis after focal seizure; start antiepileptic drug
• C Hemiplegic migraine; prescribe triptans
• D Transient ischemic attack; start antiplatelet therapy and address vascular risk factors urgently ✓

Explanation

A transient ischemic attack (TIA) is defined as a brief neurological deficit due to focal brain ischemia without persistent infarction on DWI-MRI. The ABCD2 score helps risk stratify TIA for early stroke risk; this patient's age, hypertension, and hemibody deficit place him at high risk. Urgent antiplatelet therapy (aspirin with or without clopidogrel for 21 days per POINT/CHANCE trials), aggressive vascular risk factor management, and early specialist evaluation reduce subsequent stroke risk by up to 80%.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.