Ministroke, Not A Small Matter
TIA Diagnosis Lulls Patients and Physicians Into False Sense of Security
Feb. 9, 2004 (San Diego) -- Big or small, all strokes should be considered serious, potentially disabling events and should be treated as such, that according to new research that casts doubt on the usefulness of ministroke as a diagnosis.
Currently stroke experts use the term transient ischemic attack or TIA to characterize the so-called ministroke that causes brief episodes of stroke symptoms caused by momentary interruptions in the blood supply to the brain.
Traditionally, TIAs were regarded as potential precursors or warning signs of stroke. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours. Symptoms can include: numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; and difficulty with walking, dizziness, or loss of balance and coordination.
But stroke experts meeting here for the 29th International Stroke Conference report that the common use the ministroke diagnosis is often misleading and could actually lead to mismanagement of stroke patients. So, they are now urging that all stroke symptoms -- even those that last only moments -- should be taken seriously.
S. Claiborne Johnston, MD, PhD, of the University of California at San Francisco says TIA patients should be hospitalized for 24 hours, an approach that he says is cost-effective because the risk of stroke during that time period is so high in these patients.
Johnston analyzed medical records from TIA patients evaluated in emergency departments at 11 San Francisco Bay area hospitals. He and his colleagues discovered that if the patients were admitted for 24-hour observation, "a new stroke could be identified in the first hour of onset." That speedy recognition is important because it allowed the patients to be treated with clot-busting drugs that can only be given within three hours of stroke onset.
Johnston and his colleagues also studied the risk of stroke following an initial hospitalization for TIA and reported that more than 16% of patients will have a full-blown stroke within three months of the first TIA, and that number climbs to more than 18% at six months and 21% at a year. "These numbers are higher than previously published," Johnston said at a press conference. "So you can see that TIAs are not benign."
Robert Adams, MD, professor of neurology at the University of Georgia, says stroke activity appears to be greatest during the first 48 hours following diagnosis of TIA. "These patients need to be kept in the system. We need to follow-up during the first 24 hours to determine the cause of the TIA. The patient needs a [neurological] work-up and referral for special consultation," Adams says. Adams moderated a press conference about the controversy surrounding TIA as a diagnosis.