Minor strokes should be treated as a medical emergency: study

By Mark Waghorn via SWNS

Minor strokes should be treated as a medical emergency - like a heart attack, according to a new study.

Symptoms usually disappear after a few minutes - leading to them being wrongly regarded as a "gentle warning."

But scientists say that nearly one in five patients will go on to have a full-blown stroke within three months - around half in the next couple of days.

The American Heart Association said they need an immediate assessment and new statement offers specific guidance for health care professionals.

Two-fifths, given the appropriate scan, will learn they have actually had a stroke instead of a transient ischaemic attack (TIA) or mini-stroke.

Comprehensive scans may help determine high-risk individuals who should be hospitalized.

Writing committee chair professor Hardik Amin, of Yale New Haven Hospital said: "Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room.

"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 health care centres or varying levels of comfort and experience among medical professionals."

The advice published in the journal Stroke is aimed specifically at hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.

A TIA is a temporary blockage of blood flow to the brain. At least 240,000 people are affected in the US each year. The number is probably higher due to under-reporting.

It doesn't cause permanent damage - but roughly ten percent will have a full-blown attack within two days.

A TIA is more accurately described as a warning stroke rather than a 'mini-stroke' as it's often called.

Symptoms are the same as stroke - only temporary. They begin suddenly and may have any or all of these characteristics:

• Symptoms begin strong then fade
• Symptoms typically last less than an hour
• Facial droop
• Weakness on one side of the body
• Numbness on one side of the body
• Trouble finding the right words/slurred speech
• Dizziness, vision loss or trouble walking.

The F.A.S.T. acronym for stroke symptoms can be used to identify a TIA: F ― Face drooping or numbness; A ― Arm weakness; S ― Speech difficulty; T ― Time to call 9-1-1, even if the symptoms go away.

Amin said: "Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation that they would at a certified stroke centre.

"This statement was written with those emergency room physicians or internists in mind – professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging evaluation and treatment decisions."

The statement also includes guidance to help health care professionals tell the difference between a TIA and a 'TIA mimic'.

The condition shares similarities with TIA but can be due to low blood sugar, a seizure or a migraine. Symptoms tend to spread to other parts of the body and build in intensity over time.

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 risk of a TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea and coronary artery disease.

In addition, a person who has had a prior stroke is at high risk for TIA.

After assessing for symptoms and medical history, imaging of the blood vessels in the head and neck is an important first assessment.

A CT head scan should be done initially in the emergency department to rule out intracerebral hemorrhage or a TIA.

CT angiography may be done as well 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 that lead to the brain.

An MRI (magnetic resonance imaging) scan is the preferred way to rule out a stroke, ideally done within 24 hours of when symptoms began.

About 40% of patients presenting in the ER 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 they may admit the patient to the hospital for MRI or transfer them to a center with rapid 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 like diabetes and high cholesterol.

Once TIA is diagnosed, a cardiac work-up is advised due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department.

It could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having 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 a stroke or TIA.

Amin said: "Incorporating these steps for people with suspected TIA may help identify which patients would benefit from hospital admission, versus those who might be safely discharged from the emergency room with close follow-up.

"This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke."

Stroke affects about 100,000 Britons annually. There are 1.3 million survivors in the UK.