New Guidelines Recommend Emergency Assessment for TIA, Even if Symptoms Disappear

By Tamara Thomas - Last Updated: March 13, 2023

Suppose you experience stroke symptoms, also called a transient ischemic attack (TIA). It is crucial to seek medical attention immediately, even if these symptoms disappear in under an hour. According to a new American Heart Association scientific statement published in the Association’s journal, Stroke, this countermeasure will help prevent future complete strokes.

The recent statement offers a standardized approach for assessing individuals suspected of having a TIA, along with specific recommendations tailored toward hospitals in rural areas that lack sophisticated imaging or a resident neurologist.

According to the statement, each year, over 240,000 people in the US undergo a TIA. However, this number may underestimate the occurrence rate since the symptoms frequently resolve within an hour. Furthermore, the statement noted that although a TIA does not result in lasting harm, nearly 20% of individuals who have a TIA will have a complete stroke within 3 months, and roughly half of them experiencing one within 48 hours.

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, MD, associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “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 centers, or varying levels of comfort and experience among medical professionals.”

“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 center. 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,” Amin said.

The statement also provides instructions to assist health care providers in distinguishing between a TIA and a “TIA mimic,” which is a medical condition that exhibits similar symptoms to a TIA but is brought on by other factors like low blood sugar, seizure, or migraine. Signs of a TIA mimic usually extend to other body regions and escalate in severity over some time.

According to the statement, when a patient is in the emergency room with symptoms of a TIA, the first step is to conduct a non-contrast head computerized tomography (CT) to check for intracerebral hemorrhage and TIA mimics. In addition, an examination may include a CT angiography to look for the narrowing of the arteries leading to the brain. Blood work is also done to rule out other conditions that may cause TIA-like symptoms.

After TIA diagnosis, the researchers suggest a cardiac workup due to the potential for heart-related factors in TIA causation. The statement also recommends following up with a neurologist within 48 hours, but not longer than 1 week after a TIA, given the high risk of stroke in the days after this event.

The statement emphasizes the importance of collaboration among emergency room professionals, neurologists, and primary care professionals to provide a comprehensive evaluation and well-communicated outpatient plan for stroke prevention to the patient at discharge.

“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,” Amin said. “This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke.”

Source: ScienceDaily 

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