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

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Statement Highlights:

  • Diagnosing a transient ischemic attack (TIA), sometimes called a “warning stroke,” is challenging because the symptoms usually resolve within an hour.

  • A new scientific statement from the American Heart Association outlines how to evaluate patients who experience a TIA, with specific guidance for healthcare providers in rural areas.

  • Nearly one out of five people with a suspected TIA will have a full stroke within three months, and two out of five, after proper examination, will know that they actually had a stroke rather than a TIA.

  • Comprehensive evaluation of patients with suspected TIA with imaging and use of risk assessment scores can help determine which patients should be hospitalized because they are at increased risk of total stroke.

Embargoed until 4 a.m..m. CT / 5am ET Thursday, January 19, 2023

(NewMediaWire) – Jan 19, 2023 – DALLAS Symptoms of stroke that go away in less than an hour, known as a transient ischemic attack (TIA), need emergency evaluation to help prevent a full stroke, according to a new scientific statement from the American Heart Association published today in the journal of the Association Leakage. 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 a local neurologist.

TIA is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the US experience a TIA, although this estimate may represent underreporting of TIAs because symptoms tend to clear up within an hour. Although the TIA itself does not cause permanent damage, nearly 1 in 5 of those who have a TIA will have a full stroke within three months of the TIA, nearly half of which will occur 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.

TIA symptoms are the same as stroke symptoms, only temporary. They start suddenly and can have some or all of these characteristics:

  • Symptoms start out strong and then fade away;

  • Symptoms usually last less than an hour;

  • Facial fall;

  • Weakness on one side of the body;

  • Numbness on one side of the body;

  • Difficulty finding the right words/slurred speech or

  • Dizziness, vision loss or difficulty walking.

The acronym FAST for stroke symptoms can be used to identify a TIA: F droopy or numb face; AN Arm weakness; s Speech difficulty; T Time to call 9-1-1 even if the symptoms go away.

“Confidently diagnosing a TIA is difficult, as most patients are back to normal function by the time they arrive in the ER,” said Hardik P. Amin, MD, Chair of the Scientific Statements Writing Committee and Associate Professor. of neurology and medical director of stroke. at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “There is also nationwide variability in the exam 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.”

For example, Amin said, “Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation they would at a certified stroke center. This statement was written with the emergency physicians or internists at professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging assessments and treatment decisions.”

The statement also includes guidance to help healthcare professionals distinguish between a TIA and a “TIA mimic”, a condition that shares some signs with TIA but is due to other medical conditions such as low blood sugar, seizure or migraine. Symptoms of a mimic TIA tend to spread to other parts of the body and increase in intensity over time.

Who is at risk for a TIA?

People with cardiovascular risk factors such as high blood pressure, diabetes, obesity, high cholesterol and smoking are at high 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 previous stroke is at high risk for a TIA.

Which tests come first once in the emergency room?

After evaluating the symptoms and medical history, imaging the blood vessels in the head and neck is an important first assessment. A non-contrast head CT scan should be performed initially in the emergency department to rule out intracerebral hemorrhage and TIA shams. CT angiography may also be done to look for signs of narrowing in the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowing of the large arteries leading to the brain.

An magnetic resonance imaging (MRI) is the preferred way to rule out brain injury (i.e. a stroke), ideally performed within 24 hours of the onset of symptoms. About 40% of patients who present to the emergency room with TIA symptoms will actually be diagnosed with a stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner and may admit the patient to the hospital for an MRI or transfer them to a center with quick access to one.

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 exam is recommended due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department, however it can be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of a TIA. An electrocardiogram to assess heart rhythm is suggested to screen for atrial fibrillation, which is detected in up to 7% of people with stroke or TIA. The American Heart Association recommends that long-term cardiac monitoring within six months after a TIA is reasonable if the initial evaluation suggests a heart rhythm problem as the cause of a TIA or stroke.

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

Assessment of stroke risk after TIA

A quick way to assess a patient’s future stroke risk after TIA is the 7-point ABCD2 score, which stratifies patients into low, medium, and high risk based on ANge, Bblood pressure, Çclinical features (symptoms), Dduration of symptoms (less than or greater than 60 minutes) and Ddiabetes. A score of 0-3 indicates low risk, 4-5 is moderate risk, and 6-7 is high risk. Patients with moderate to high ABCD2 scores may be considered for hospitalization.

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

“Incorporating these steps for people with a suspected TIA could help identify which patients would benefit from a hospital stay versus those who could safely be discharged from the ER with close follow-up,” said Amin. “This guideline empowers clinicians in rural and urban academic settings with information to help reduce future stroke risk.”

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Emergency Neurovascular Care Committee 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 is endorsed by the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS).

The American Heart Association’s scientific statements promote greater awareness of cardiovascular disease and stroke issues and help facilitate informed health care decisions. Scientific statements describe what is currently known about a topic and which areas need further research. Although scientific statements inform guideline development, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice President Tracy E. Madsen, MD, Ph.D.; Dawn M. Bravata, MD; Charles R. Wira, 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

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceuticals, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the content of science. Revenues from pharmaceutical and biotechnology companies, device manufacturers and health insurance providers and general financial information for the Association are available here.

Additional Resources:

  • VIDEO interview clips with Hardik P. AminMD, chairman of the scientific statement writing committee and associate professor of neurology and medical director of stroke at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut and Tracy E. MadsenMD, Ph.D., vice president of statement and associate professor of emergency medicine at Alpert Medical School at Brown University in Providence, Rhode Island and other multimedia resources are in the right column of the press release link https:// newsroom.heart.org /news/stroke-symptoms-even-if-gone-within-an-hour-need-emergency-evaluation?preview=361925e00941224992d847f3bef6ba85

  • spanish press release

  • After January 19, view the manuscript online.

  • AHA Press Release: Twenty Things You Didn’t Know About Stroke That Could Save a Life (May 2018)

  • AHA Practice Guideline: 2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (May 2021)

  • Follow AHA/ASA news on Twitter @HeartNews

About the American Heart Association

The American Heart Association is an unrelenting force for a world of longer, healthier lives. We are committed to ensuring equitable health in all communities. Through collaboration with multiple 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. Connect with us at heart.org, Facebook, twitter or by calling 1-800-AHA-USA1.

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For media inquiries: 214-706-1173

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

For public inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

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