American Board of Psychiatry and Neurology (ABPN) Practice Exam

Which of the following is not a symptom associated with a transient ischemic attack in the carotid territory?

1. Contralateral homonymous visual field defects

2. Cramping in the legs

3. Aphasia

4. Contralateral body weakness

The correct answer is: Cramping in the legs

Transient ischemic attacks (TIAs) are brief episodes of neurological dysfunction caused by focal brain ischemia that typically last less than 24 hours, often presenting with symptoms depending on the area of the brain affected. In the carotid territory, individuals may experience various symptoms reflective of unilateral cerebral hemisphere involvement, such as contralateral body weakness, aphasia, and, in some cases, visual field defects. Contralateral homonymous visual field defects can occur when the ischemia affects the optic pathways, typically involving the occipital lobe. Aphasia may arise if the left cerebral hemisphere, which is commonly associated with language function, is affected. Furthermore, contralateral body weakness, a common manifestation of TIAs, occurs due to disruption of the motor pathways in the brain. On the other hand, cramping in the legs is not typically associated with TIAs in the carotid territory. This symptom is more indicative of peripheral vascular disease or other neurological issues unrelated to the specific transient ischemic events affecting cerebral circulation. Therefore, it does not fit the typical symptomatology associated with a TIA, particularly in the context of carotid territory involvement.