Ministroke, Not A Small Matter
TIA Diagnosis Lulls Patients and Physicians Into False Sense of Security
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.
"I would admit every patient with TIA to the hospital," says German stroke expert Orell Mielke, MD, at Neurologische Universitatsklinik of Klinikum Manheim in Germany. "It makes no sense to separate TIA from stroke. TIAs and strokes are both accidents in the progression of the same disease," he says.
Mielke presented results of a six-month follow-up of 1,380 TIA patients and 3,850 ischemic stroke patients. At the end of six months, 6.2% of TIA patients had died compared with 16.2% of stroke patients. Twenty-two percent of TIA patients were dependent compared with 41% of stroke patients.
Each among the three researchers agrees the TIA diagnosis is misleading. Johnston says the diagnosis probably contributes to complacency, which actually increases the risk for patients.
"In fact, even though it sounds counterintuitive, TIA patients have an increased risk of deterioration and poor recovery with a stroke [compared with] stroke patients," Johnston says.