Background <p>Patient symptoms have not been a primary consideration in ischemic stroke management. However, symptom evaluation in ischemic stroke may enhance the quality of care and improve prognosis. Therefore, in this study, we aimed to determine the factors associated with symptom relief and lesions in ischemic stroke and transient ischemic attack (TIA).</p> Methods <p>This retrospective study included patients with ischemic stroke or TIA between April 2020 and February 2024 in a tertiary regional general hospital. The 2436 patients who met the inclusion criteria were classified based on symptom persistence and the presence of stroke lesions. Factors related to symptom relief and lesion formation were analyzed using comparative and multivariate regression analyses.</p> Results <p>Through multivariate regression analysis, we identified significant factors, including age, stroke size, absence of white matter hyperintensities, absence of microbleeds, and the National Institutes of Health Stroke Scale (NIHSS) score at admission, that affect symptom relief in patients with ischemic stroke lesions. Significant factors affecting lesion formation in patients with ischemic stroke and symptom relief were the NIHSS score at admission, atrial fibrillation, and alcohol intake. The results demonstrated that pathological changes in the brain, pre-existing brain damage, and stroke lesions can prevent symptom relief. The NIHSS score, which indicates stroke severity, was associated with symptom relief and the presence of stroke lesions. Stroke lesion formation was associated with alcohol intake and the presence of atrial fibrillation.</p> Conclusions <p>These findings provide valuable insights for the development of management strategies that improve the treatment and prognosis of patients with acute ischemic stroke.</p>