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Health

‘Warning stroke’: What it is and why you shouldn’t dismiss the symptoms

  • The American Heart Association released a statement urging people who experience stroke-like symptoms to receive an emergency assessment for stroke.
  • They noted that 10-18% of those with a ‘transient stroke’ have a stroke within 90 days.
  • They hope their guidelines will help clinicians improve the care provided to those at risk of stroke.

Every year, 795,000 people in the United States experience stroke. Of these, close to 610,000 experience the condition for the first time, and 137,000 die.

Around 87% of strokes in the U.S. are ischemic strokes, which happen when blood flow to the brain is blocked.

Transient ischemic attack (TIA) happens when stroke-like symptoms occur for a few minutes or hours and then disappear. Just like a stroke, symptoms usually begin suddenly.

The exact number of TIA cases in the U.S. is difficult to determine due to its transient nature and lack of standardized surveillance. However, estimates suggest that at least 240,000 people experience TIA yearly in the U.S.

Research also suggests that 10- 18% of TIAs result in stroke within 90 days. A study found that 31% of patients who experienced a recurrent stroke within 90 days of the first TIA had not sought medical attention after their TIA.

To better monitor stroke risk, the American Heart Association (AHA) recently published a statement urging those with TIA symptoms to seek an emergency assessment.

“A TIA is an actual stroke, however, the symptoms resolve in less than one hour, and the patient returns to normal function,” Dr. Ronald Grifka, a cardiologist and Chief Medical Officer with the University of Michigan Health-West, who was not involved in crafting the statement, told Medical News Today.

“The symptoms resolve in such a short period of time, often before a patient can get to the Emergency Room and be evaluated thoroughly. Because the stroke symptoms resolve so quickly, many patients develop a false sense of security, and do not seek medical evaluation,” he added.

“It is important to remember that even if the stroke symptoms resolve quickly, the recent AHA study confirmed that an emergent medical evaluation is necessary, as nearly one in five people who have a TIA will have a full-blown stroke within three months, and a high percentage will learn that they actually had a stroke not a TIA.”
— Dr. Ronald Grifka

TIA is a temporary blockage of blood flow to the brain. Almost half of the strokes in those following a TIA occur within two days. For this reason, TIA is often described as a ‘warning stroke’. Symptoms include:

  • face drop on one side
  • inability to lift both arms and keep them there due to weakness or numbness
  • slurred or garbled speech or inability to speak
  • complete paralysis on one side of the body
  • sudden vision loss, blurred vision, or double vision
  • vertigo
  • confusion
  • problems with balance and coordination

“Even a single and individual neurologic symptom should be evaluated emergently, if new and sudden in onset,” Dr. Amanda Jagolino-Cole, vascular neurologist with UTHealth Houston and Memorial Hermann, who was not involved in crafting the statement, told MNT.

“Severity of symptoms and duration of symptoms are less important than the type of symptoms […] and the acuity of onset when deciding whether to seek out emergent versus routine care,” she added.

“For example, a patient with a complex migraine may have weakness on one side as a cause of the headache. At the same time, a stroke causing new-onset weakness on one side can also have an associated headache, as there is a known association between a new stroke and headache,” she said.

“For patients with a history of headaches, a change in the headache symptomology or frequency, associated with a neurologic symptom, should be evaluated emergently,” she noted.

Risk factors for TIA include:

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Dr. Hardik P. Amin, associate professor of neurology, medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut, and one of the study’s authors in a press release.

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

Dr. Hardik noted that the AHF statement was written to help healthcare professionals differentiate between TIA and ‘TIA mimics’. TIA mimics share similar symptoms with TIA’s but results from other medical conditions, including low blood sugar, seizures, or migraines.

Upon entering the emergency room, the AHA recommends a non-contrast head CT scan to rule out intracerebral hemorrhage or TIA mimics. However, they noted it has limited utility in patients whose symptoms have resolved.

They noted that magnetic resonance imaging (MRI) should also be used to distinguish TIA from stroke and that it should be carried out within 24 hours of symptom onset for best results. Around 40% of patients with TIA symptoms in the emergency room will receive a stroke diagnosis from MRI results.

The researchers wrote that if MRI is available, a non-contrast CT scan may be skipped.

Next, they recommended blood tests to rule out conditions such as low blood sugar or infections and to check for cardiovascular risk factors, including diabetes and high cholesterol.

They also recommended an electrocardiogram to assess heart rhythm and for patients to receive an early neurology consultation within 48 hours to a week of symptom onset.

The ABCD2 score

To assess for stroke risk after TIA, the AHA recommends the 7-point ABCD2 score, which evaluates stroke risk according to the following:

  • age
  • blood pressure
  • clinical features (symptoms)
  • duration of symptoms
  • diabetes status

The researchers noted that there are disparities in stroke care between urban and rural populations. To address these, they recommend the development of online ‘telestroke networks’ to provide rural and under-resourced communities with greater access to vascular neurologists.

“This is a long-needed Scientific Statement that accurately portrays TIA as a neurologic emergency that requires expeditious diagnosis and treatment,” Dr. Fernando Testai, professor of neurology at the University of Illinois at Chicago, who was also not involved in making the AHA statement, told MNT.

“The neurology field long ago departed from the concept of ‘diagnose and adios’ for TIAs. Thus, rapid access to a vascular neurologist, either in person or through telemedicine, is an avenue to rapidly identify the cause of the TIA and institute patient-specific stroke prevention strategies, including culturally-tailored individualized lifestyle changes.”
— Dr. Fernando Testai

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