Immediate evaluation required even if stroke symptoms disappear within 1 hour

A stroke symptom known as a transient ischemic attack (TIA) that resolves within an hour requires urgent evaluation to prevent a full-blown stroke, according to the American Heart Association journal today. According to a new scientific statement that strokeThis statement provides a standardized approach for evaluating people with suspected TIAs and provides guidance for hospitals in rural areas that may not have access to advanced imaging or on-site neurologists. increase.

A TIA is a temporary blockage of blood flow to the brain. Approximately 240,000 people in the U.S. experience his TIA each year, but symptoms tend to go away within an hour for him, so this estimate may represent an underreporting of his TIA. I have. Although a TIA itself does not cause permanent damage, nearly one in five of his TIA patients had a full-blown stroke within three months after his TIA, and nearly half of them Happens within 2 days. For this reason, a TIA is more accurately described as a warning stroke rather than a “ministroke” as it is often called.

The symptoms of a TIA are the same as those of a stroke and are temporary. They start abruptly and may have some or all of the following characteristics:

• Symptoms begin strongly and then disappear.
• Symptoms usually last for less than an hour.
• sagging of the face;
• weakness on one side of the body;
• numbness on one side of the body;
• Difficulty finding the right words/slurred; and
• Dizziness. Decreased vision. Difficulty walking.

The FAST acronym for stroke symptoms can be used to identify TIAs. debt – facial sagging and numbness; Ah – arm weakness; S. – language difficulties; T. – Even if symptoms subside, it’s time to call 9-1-1.

“It is difficult to confidently diagnose a TIA because most patients have returned to normal function by the time they reach the emergency room,” said Dr. said Hardik P. Amin, MD, Associate Professor of Medicine, Department of Medicine and Stroke. at Yale New Haven Hospital on the St. Raphael Campus in New Haven, Connecticut. “Also, there is variation across countries in the scrutiny a TIA patient may undergo, which may be due to geographic factors, limited resources of medical centers, or differing levels of comfort and experience of medical professionals. there is potential.”

For example, Amin says: In resource-limited areas where vascular neurologists may not be readily accessible and difficult evaluation and treatment decisions must be made. ”

The statement includes information to help healthcare professionals distinguish between TIAs and “TIA mimics” (which share some symptoms with TIAs but are due to other medical conditions such as hypoglycemia, seizures, and migraines). Guidance is also included. TIA mimic symptoms tend to spread to other parts of the body and increase in intensity over time.

Who is at risk of TIA?

People with cardiovascular risk factors such as hypertension, diabetes, obesity, high cholesterol and smoking are at increased risk of stroke and TIA. Other conditions that increase the risk of TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea, and coronary artery disease. Additionally, people who have had a previous stroke are at increased risk of a TIA.

Which test is done first in the emergency room?

Imaging of blood vessels in the head and neck is an important first evaluation after evaluating symptoms and history. A non-contrast head CT should be done first in the emergency department to rule out intracerebral hemorrhage and TIA mimicry. A CT angiogram may be done to look for signs of narrowing of the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowed large arteries leading to the brain.

A magnetic resonance imaging (MRI) scan is the preferred method to rule out brain damage (ie, stroke), ideally within 24 hours of the onset of symptoms. About 40% of patients presenting to the ER with symptoms of a TIA are actually diagnosed with stroke based on MRI results. In some emergency rooms he may not have access to an MRI scanner and may admit the patient to a hospital for an MRI or transfer the patient to a center with quick access.

Complete blood tests at the emergency department to rule out other conditions that can cause TIA-like symptoms, such as hypoglycemia or infections, and to check for cardiovascular risk factors such as diabetes and high cholesterol is needed.

Once a TIA is diagnosed, a cardiac workup is recommended as heart-related factors can cause a TIA. Ideally, this evaluation will be done in the emergency department, but it can also be arranged as a follow-up visit with an appropriate specialist, preferably within one week after he undergoes the TIA. ECG to assess heart rhythm is recommended for screening for atrial fibrillation, which is detected in up to 7% of stroke or TIA patients. The American Heart Association recommends that if initial evaluation suggests a heart rhythm-related problem as the cause of his TIA or stroke, long-term cardiac monitoring within 6 months of his TIA is reasonable. doing.

Early neurologic consultation, either in person or by telemedicine, is associated with reduced mortality after TIA. If consultation is not possible during an emergency visit, the statement states that the risk of stroke is high for several days after a TIA, so ideally he should see a neurologist within 48 hours, but within a week after the TIA. I suggest you follow up. The statement cites a study that found that about 43% of people who have had an ischemic stroke (caused by a blood clot) developed a TIA one week before the stroke.

Assessment of stroke risk after TIA

A rapid method to assess future stroke risk in patients after a TIA includes age, blood pressure, clinical features (symptoms), duration of symptoms (shorter or longer than 60 minutes) and diabetes. A score of 0-3 indicates low risk, 4-5 moderate risk, and 6-7 high risk. A patient with moderate to high her ABCD2 score may be considered for hospitalization.

Collaboration between emergency room specialists, neurologists, and primary care specialists ensures that patients receive a comprehensive evaluation and well-communicated outpatient plan for future stroke prevention at discharge. important to ensure that

“Incorporating these procedures in people with suspected TIAs may help identify patients who would benefit from hospitalization and those who can be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance provides physicians in both rural and urban education settings with information to help reduce the risk of future stroke.”

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association’s Emergency Neurovascular Care Committee of the Stroke Council and the Peripheral Vascular Disease Council. The American Academy of Neurology recognizes the value of this statement as an educational tool for neurologists and is endorsed by the American Association of Neurosurgeons/Conference of Neurosurgeons (AANS/CNS).

Scientific statements from the American Heart Association help raise awareness and facilitate informed health care decisions about cardiovascular disease and stroke issues. A scientific statement outlines what is currently known about the topic and areas where additional research is needed. Scientific statements inform the development of guidelines but do not make treatment recommendations. The American Heart Association guidelines provide the association’s official clinical practice recommendations.

Co-author is Vice Chair Tracy E. Madsen, MD, Ph.D. Dawn M. Bravata, MD. Charles R. Willa, MD. S. Claiborne Johnston, MD, Ph.D.; Susan Ashcraft, DNP. Tamika Marquitta Burrus, MD. Peter David Panagos, MD. Max Wintermark, MD, MAS; and Charles Esenwa, MD, MS