Stroke symptoms, even if they go away within an hour, need emergency evaluation

Statement highlights:

  • Diagnosing a transient ischemic attack (TIA), sometimes called a “warning stroke,” is difficult because symptoms often go away within an hour.

  • A new American Heart Association scientific statement describes how to evaluate patients with a TIA, with specific guidance for healthcare professionals in rural areas.

  • Approximately one in five people suspected of having a transient ischemic attack will have a full-blown stroke within three months, and two in five people will know, given proper examination, that they actually had a stroke rather than a TIA.

  • Thorough evaluation of suspected TIA patients with imaging and use of risk assessment scores may help determine which patients should be hospitalized because they are at higher risk of a full-blown stroke.

Restricted until 4 a.m.m. CT/5 AM ET Thursday, January 19, 2023

(NewMediaWire) — January 19, 2023 — Symptoms of a Dallas stroke that disappear in less than an hour, known as a transient ischemic attack (TIA), need emergency evaluation to help prevent a full-blown stroke, according to a new American Heart Association scientific statement published today. in the Society’s Journal Apoplexy. The statement provides a standardized approach for assessing people with suspected transient ischemic seizure, with special guidance for hospitals in rural areas that may not have access to advanced imaging or a neurologist on site.

TIA It is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the United States experience a TIA, although this estimate may underreport TIA because symptoms tend to disappear within an hour. While a TIA itself does not cause permanent damage, approximately 1 in 5 who have a TIA will have a full-blown stroke within three months after a TIA, and about half will occur within two days. For this reason, a transient ischemic attack is accurately described as a warning stroke rather than a “mini-stroke,” as it is often called.

The symptoms of a transient ischemic attack are the same Stroke symptoms, only temporary. It begins suddenly and may have any or all of these characteristics:

  • Symptoms start strong and then go away.

  • Symptoms usually last less than an hour;

  • facial drooping

  • Weakness on one side of the body.

  • Numbness on one side of the body.

  • trouble finding the correct words/ slurred speech; or

  • Dizziness, loss of vision, or trouble walking.

The FAST acronym for stroke symptoms can be used to define a TIA: F Facial drooping or numbness. a Arm weakness s Difficulty speaking t It’s time to call 9-1-1, even if your symptoms are gone.

Hardik Amin, chair of the scientific statement writing committee and assistant professor of neurology and director of clinical stroke, Hardik P. at Yale New Haven Hospital, Saint Raphael Campus in New Haven, Connecticut. “There is also variance across the country in the work that TIA patients may receive. This may be due to geographic factors, limited resources in healthcare centers, or different levels of comfort and experience among medical professionals.”

For example, Amin said, “A person who has a TIA and goes to the emergency room with limited resources may not get the same evaluation they would at a certified stroke center. This statement was written with emergency room physicians or internists in mind who specialize in areas Limited by resources they may not have immediate access to a vascular neurologist and must make difficult evaluation and treatment decisions.”

The statement also includes guidance to help healthcare professionals know the difference between a TIA and a “mimic TIA,” a condition that shares some signs with a TIA but is caused by other medical conditions such as low blood sugar, seizure, or migraine. The symptoms of a TIA tend to spread to other parts of the body and get more severe over time.

Who is at risk of TIA?

People with risk factors for cardiovascular disease, such as high blood pressure, diabetes, obesity, high cholesterol, and smoking, are at increased risk of stroke and transient ischemic attack. Other conditions that increase the risk of TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea, and coronary artery disease. In addition, a person who has had a previous stroke is at risk of having a transient ischemic attack.

What tests come first in the emergency room?

After evaluating symptoms and medical history, head and neck angiography is an important first evaluation. Non-contrast CT should be performed initially in the emergency department to rule out intracerebral hemorrhage and to simulate a TIA. A CT angiogram 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 that lead to the brain.

Magnetic resonance imaging (MRI) is the preferred method for excluding brain injury (i.e. stroke), ideally performed within 24 hours of the onset of symptoms. About 40% of patients who show up in the emergency room with symptoms of a TIA will actually be diagnosed with a stroke based on the MRI findings. Some emergency rooms may not have access to an MRI scanner, and the patient may be admitted to the hospital for an MRI or transferred to a center with rapid access to it.

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 a TIA is diagnosed, a cardiac examination is recommended because of the potential for TIA to be caused by heart-related factors. Ideally, this assessment would take place in the emergency department, however, it could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having a TIA. An electrocardiogram to evaluate heart rhythm is suggested for screening for atrial fibrillation, which is detected in up to 7% of people with a stroke or TIA. American Heart Association recommend Long-term cardiac monitoring within six months of a TIA is reasonable if the initial evaluation indicates a problem with the heart rhythm as the cause of the TIA or stroke.

Early consultation of a neurologist, either in person or by telemedicine, is associated with lower mortality rates after a transient ischemic attack. If counseling is not possible during an emergency visit, the statement suggests follow-up with a neurologist ideally within 48 hours but no more than 1 week after the TIA, due to the higher risk of stroke in the days following the TIA. The statement cites research showing that about 43% of people who have had a stroke (caused by a blood clot) had a transient ischemic attack within a week before the stroke.

Stroke risk assessment after transient ischemic attack

A quick way to assess a patient’s risk of having a future stroke after a TIA is the 7-point ABCD2 score, which divides patients into low, intermediate and high risk based on aGeneral Electric Bair pressure , clinear features (symptoms), DrSymptomatic urination (less than or more than 60 minutes) f DrDiabetes. A score of 0 to 3 indicates low risk, a score of 4 to 5 indicates moderate risk, and 6 to 7 indicates high risk. Patients with moderate to high ABCD2 scores may be considered hospitalized.

Collaboration between emergency room specialists, neurologists, and primary care professionals is critical to ensuring that the patient receives a comprehensive assessment and a well-communicated outpatient plan for future stroke prevention upon discharge.

“Incorporating these steps for people with suspected TIA may help identify patients who would benefit from hospitalization, versus those who might be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance empowers clinicians in both rural and urban academic settings with information to help reduce future stroke risks.”

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

The American Heart Association’s scientific data promote greater awareness of cardiovascular disease and stroke issues and help facilitate informed healthcare decision-making. Scientific data defines what is currently known about a topic and which areas need additional research. While scientific data helps develop guidelines, it does not provide treatment recommendations. American Heart Association guidelines provide the association’s official clinical practice recommendations.

Co-authors are Vice President Tracy E. Madsen, MD, PhD; Dawn M. Bravata, MD; Charles R Wera, MD; S. Claiborne Johnston, MD, PhD; Susan Ashcraft, DNP; Tamika Marquita-Burros, MD; Peter David Panagos, MD; Max Wintermark, MD, Mass; and Charles Esenua, MD, MA

The association receives funding primarily from individuals. Foundations and companies (including pharmaceutical companies, device manufacturers, and other companies) make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing scholarly content. Revenue from pharmaceutical and biotechnology companies, device manufacturers and health insurance providers, and general financial information for the association is available here.

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are committed to ensuring equitable health in all communities. By collaborating with many organizations, and supported by millions of volunteers, we fund innovative research, advocate for public health and share life-saving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Contact us on heart.orgAnd FacebookAnd Twitter or by calling 1-800-AHA-USA1.

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Maggie Francis: 214-706-1382; Maggie.Francis@heart.org

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