'Warning stroke': What it is and why you shouldn't dismiss the symptoms

• The American Heart Association released a statement urging people who experience stroke-like symptoms to receive an emergency assessment for stroke.
• They noted that 10-18% of those with a ‘transient stroke’ have a stroke within 90 days.
• They hope their guidelines will help clinicians improve the care provided to those at risk of stroke.

Every year, 795,000 people in the United States experience stroke. Of these, close to 610,000 experience the condition for the first time, and 137,000 die.

Around 87% of strokes in the U.S. are ischemic strokes, which happen when blood flow to the brain is blocked.

Transient ischemic attack (TIA) happens when stroke-like symptoms occur for a few minutes or hours and then disappear. Just like a stroke, symptoms usually begin suddenly.

The exact number of TIA cases in the U.S. is difficult to determine due to its transient nature and lack of standardized surveillance. However, estimates suggest that at least 240,000 people experience TIA yearly in the U.S.

Research also suggests that 10- 18% of TIAs result in stroke within 90 days. A study found that 31% of patients who experienced a recurrent stroke within 90 days of the first TIA had not sought medical attention after their TIA.

To better monitor stroke risk, the American Heart Association (AHA) recently published a statement urging those with TIA symptoms to seek an emergency assessment.

Warning stroke symptom check

TIA is a temporary blockage of blood flow to the brain. Almost half of the strokes in those following a TIA occur within two days. For this reason, TIA is often described as a ‘warning stroke’. Symptoms include:

• face drop on one side
• inability to lift both arms and keep them there due to weakness or numbness
• slurred or garbled speech or inability to speak
• complete paralysis on one side of the body
• sudden vision loss, blurred vision, or double vision
• vertigo
• confusion
• problems with balance and coordination

Risk factors for TIA include:

• family history of stroke or TIA
• being age 55 or older
• being male
• high blood pressure
• diabetes
• smoking tobacco

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Dr. Hardik P. Amin, associate professor of neurology, medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut, and one of the study’s authors in a press release.

“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 healthcare centers, or varying levels of comfort and experience among medical professionals,” he added.

How to tell apart a TIA from stroke

Dr. Hardik noted that the AHF statement was written to help healthcare professionals differentiate between TIA and ‘TIA mimics’. TIA mimics share similar symptoms with TIA’s but results from other medical conditions, including low blood sugar, seizures, or migraines.

Upon entering the emergency room, the AHA recommends a non-contrast head CT scan to rule out intracerebral hemorrhage or TIA mimics. However, they noted it has limited utility in patients whose symptoms have resolved.

They noted that magnetic resonance imaging (MRI) should also be used to distinguish TIA from stroke and that it should be carried out within 24 hours of symptom onset for best results. Around 40% of patients with TIA symptoms in the emergency room will receive a stroke diagnosis from MRI results.

The researchers wrote that if MRI is available, a non-contrast CT scan may be skipped.

Next, they recommended blood tests to rule out conditions such as low blood sugar or infections and to check for cardiovascular risk factors, including diabetes and high cholesterol.

They also recommended an electrocardiogram to assess heart rhythm and for patients to receive an early neurology consultation within 48 hours to a week of symptom onset.

The ABCD2 score

To assess for stroke risk after TIA, the AHA recommends the 7-point ABCD2 score, which evaluates stroke risk according to the following:

• age
• blood pressure
• clinical features (symptoms)
• duration of symptoms
• diabetes status

The researchers noted that there are disparities in stroke care between urban and rural populations. To address these, they recommend the development of online ‘Telestroke networks’ to provide rural and under-resourced communities with greater access to vascular neurologists.

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