Stroke symptoms, even those that disappear within 1 hour, need emergency attention

Individuals who have transient ischemic attacks (TIAs), which are stroke symptoms that go away in less than 1 hour, need emergency evaluation to help prevent full-blown strokes, according to a scientific statement published by the American Heart Association (AHA) in Leakage.

The statement includes a standardized approach to evaluating individuals with suspected TIA, including guidance for hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.

“Confidently diagnosing a TIA is difficult, as most patients are back to normal function by the time they arrive in the ER,” Hardik Amin, MD, Chair of the Scientific Statements Writing Committee and Associate Professor of Neurology and medical director of stroke at Yale Hospital New Haven, said in a statement.

“There is also variability across the country in the test that TIA patients may receive. This could be due to geographic factors, limited resources at health centers, or varying levels of comfort and experience among medical professionals,” said Amin.

The new statement also includes guidance designed to help healthcare professionals identify and understand the difference between a TIA and a “mimicking TIA,” which is a condition that shares some signs with a TIA but is the result of other medical conditions, including low blood sugar, migraines or seizures. TIA symptoms often spread to other parts of the body and increase in intensity over time.

TIA symptoms are the same as stroke symptoms, including facial sagging, numbness, and weakness on one side of the body, but last less than an hour.

Individuals with cardiovascular risk factors, including diabetes, high blood pressure, high cholesterol, obesity, and smoking, are at increased risk for stroke and TIA.

Other conditions can also increase your risk, including atrial fibrillation, coronary artery disease, obstructive sleep apnea, peripheral artery disease, and previous strokes.

After assessing symptoms and medical history, imaging of blood vessels in the head and neck should be evaluated per the AHA.

A CT scan can be used to rule out intracerebral hemorrhage and TIA simulations, while an MRI can rule out our brain injury.

The AHA also suggests blood tests to rule out any other conditions that may cause TIA-like symptoms and to check for cardiovascular risk factors, including diabetes and high cholesterol.

Cardiac assessment can also be used once TIA is diagnosed to help with heart-related factors that cause TIA.

“Incorporating these steps to [individuals] with suspected TIA can help identify which patients would benefit from hospital admission versus those who could safely be discharged from the ER with close follow-up,” said Amin. “This guidance equips clinicians in rural and urban academic settings with information to help reduce future stroke risk.”

In addition, clinicians should use the 7-point ABCD2 score to assess individual risk of future stroke after TIA based on age, blood pressure, clinical features, diabetes, and duration of symptoms.

Patients with a moderate (4 to 5 points) or high (6 to 7 points) score should be considered for hospitalization, according to the AHA.

Collaboration among healthcare professionals is essential to ensure that patients receive complete assessments and well-communicated outpatient plans to help prevent future strokes, according to the statement’s authors.

Reference

Stroke symptoms, even if they disappear within an hour, need emergency evaluation. EurekAlert. Press release. January 19, 2023. Accessed January 20, 2023. https://www.eurekalert.org/news-releases/976672

Stroke symptoms, even those that disappear within 1 hour, need emergency attention

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