Stroke symptoms that disappear within an hour, known as a transient ischemic attack (TIA), may help prevent a full-blown stroke, according to a new American Heart Association scientific statement published in the association’s journal Stroke. Help requires an emergency assessment. The statement offers a standardized approach to evaluating people with suspected TIA, with guidance specifically for hospitals in rural areas that may not have access to advanced imaging or on-site neurologists. TIA is a temporary blockage of blood flow to the brain.
While the TIA itself does not cause permanent damage, about 1 in 5 people who have a TIA will have a full-blown stroke within three months after the TIA, with about half within two days. For this reason, a TIA is more accurately described as a warning stroke rather than a “mini-stroke,” as it is often called. The symptoms of a TIA are similar to those of a stroke, only temporary. They begin suddenly and may have any or all of these symptoms, with symptoms usually lasting less than an hour; facial drooping; weakness on one side of the body; numbness on one side of the body; trouble finding the right word/speech; or dizziness, vision loss, or trouble walking.
FAST acronyms for stroke symptoms may be used to identify TIA: F – face drooping or numbness; a – weakness of the arm; S – speech difficulty; T – Time to call the helpline number, even if the symptoms go away. “It is difficult to confidently diagnose a TIA because most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, MD, Scientific Statement Writing Committee Chair and Associate Professor of Neurology and Medical Stroke Director. come.” Yale New Haven Hospital, on the St. Raphael Campus in New Haven, Connecticut. “There is also variability across the country in the workup TIA patients receive. This may be due to geographic factors, limited resources at health care centers, or varying levels of comfort and experience among medical professionals.”
The statement also includes guidance to help health care professionals tell the difference between a TIA and a “TIA mimic” – a condition that shares some signs with a TIA but is associated with other medical conditions such as low blood sugar, seizures or Migraines are caused by TIA mimic symptoms that spread to other parts of the body and increase in intensity over time.
Who is at risk for TIA?
People with cardiovascular risk factors such as high blood pressure, diabetes, obesity, high cholesterol and smoking are at higher risk for stroke and TIA. Other conditions that increase the risk of TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea, and coronary artery disease. Also, a person who has had a stroke before is at a higher risk of TIA.
Which tests come first in the emergency room?
After assessing symptoms and medical history, imaging of the blood vessels in the head and neck is an important first evaluation. A non-contrast head CT should initially be performed in the emergency department to exclude intracerebral hemorrhage and mimic TIA. CT angiography may also be done to look for signs of narrowing in the arteries leading to the brain. About half of people with TIA symptoms have narrowing of the large arteries leading to the brain. A magnetic resonance imaging (MRI) scan is the preferred method of ruling out a brain injury (i.e., a stroke), ideally performed within 24 hours of symptom onset. About 40% of patients presenting to the ER with TIA symptoms will actually be diagnosed with stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner, and may hospitalize the patient for an MRI or transfer them to a center with faster access. Blood work should be completed in the emergency department to rule out other conditions that may cause TIA-like symptoms, such as low blood sugar or infection, and to check for cardiovascular risk factors such as diabetes and high cholesterol.
Once TIA is diagnosed, a cardiac work-up is recommended due to the possibility of TIA being caused by heart related factors. Ideally, this assessment is performed in the emergency department, however, it can be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of the TIA occurring. An electrocardiogram to assess the heart rhythm is suggested to screen for atrial fibrillation, which is found in 7% of people who have had a stroke or TIA. The American Heart Association recommends that long-term heart monitoring within six months after a TIA is appropriate if the initial evaluation suggests a heart rhythm-related problem as the cause of the TIA or stroke. Early neurology consultation, either in person or via telemedicine, has been associated with lower mortality after TIA.
The statement cites research showing that about 43% of people who had an ischemic stroke (caused by a blood clot) had a TIA within the week before their stroke. Assessment of stroke risk after TIA A quick way to assess a patient’s risk of future stroke after a TIA is the 7-point ABCD2 score, which classifies patients based on age, blood pressure, clinical features (symptoms) as low, moderate, and low. and divides into high risk. Duration of symptoms (less than or more than 60 minutes) and diabetes. A score of 0–3 indicates low risk, a score of 4–5 indicates moderate risk, and a score of 6–7 indicates high risk. Hospitalization may be considered for patients with moderate to high ABCD2 scores.
Collaboration among emergency room professionals, neurologists, and primary care professionals is critical to ensure that the patient receives a comprehensive evaluation and a well-communicated outpatient plan for future stroke prevention. benefits from hospital admissions, versus those who can be safely discharged from the emergency room,” Amin said.