Background Our TIA service has assessed approximately 400 patients over the last 6 months. Just over half of these were TIA mimics. We present an interesting case that was initially referred to our service as a suspected TIA.

Case Summary A 51-year-old woman presented via her GP with difficulty speaking over the previous 3 weeks. Symptoms were episodic, lasting 10 min and spontaneously resolving.

During the consultation, the complaint recurred: the patient developed a sudden ‘tightness of the jaw’, rendering her unable to speak. She was both Chvostek and Trousseau sign positive.

Urgent tests revealed a severe hypocalcaemia of 1.13 mmol/l, with an ECG showing a prolonged QTc interval of 550 ms. The patient was transferred to the resuscitation room and managed with intravenous calcium replacement. Interestingly, her CT head scan showed extensive symmetrical calcifications in the basal ganglia, perivascular, cortical and subcortical regions, as well as the cerebellum. Subsequently, a diagnosis of primary hypoparathyroidism was made.

Discussion The diagnosis of TIA can be challenging, with a wide range of differential diagnoses. A comprehensive history and examination is therefore paramount. As TIA services are now designed to be easily and rapidly accessible, we suspect the rate of metabolic and other mimics may increase in line with referral numbers.