American Stroke Association meeting report
NEW ORLEANS, Feb. 3 – Transient ischemic attack (TIA) patients receive less aggressive diagnostic testing, treatment and education compared to stroke patients, which is a missed opportunity to prevent permanent disability or death, researchers reported at the American Stroke Association's International Stroke Conference 2005.
"There needs to be a paradigm shift in the way the public and physicians look at TIA," said study lead author Bhuvaneswari Dandapani, M.D., medical director of the stroke center at Holmes Regional Medical Center in Melbourne, Fla. "TIA is perceived as a much less serious condition than stroke by the public and by professionals."
About one-third of people who have TIAs, which are sometimes called "mini-strokes" will have a major stroke within five years unless they have preventive therapy.
"The public fails to understand that experiencing a TIA is a medical emergency and those who have symptoms should seek attention in the emergency room," Dandapani said. "For physicians, a TIA represents an opportunity to prevent a catastrophic stroke."
TIA symptoms are the same as stroke symptoms but last only a short time:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body; Sudden confusion, trouble speaking or understanding; Sudden trouble seeing in one or both eyes; Sudden trouble walking, dizziness, loss of balance or coordination; and Sudden, severe headache with no known cause.
Symptoms occur suddenly and vary widely, with an episode lasting from a few minutes to a few hours.
The retrospective study evaluated diagnostic tests, therapy and education of 91 TIA patients compared to 94 stroke patients. Patients' average age was 73; most were Caucasian and 58 percent were women. For almost 90 percent of the TIA patients, the TIA was their first. Of the stroke patients, 36 percent had a previous TIA or stroke, while 64 percent were first strokes.
TIA patients received less diagnostic testing than stroke patients, but nearly all TIA and stroke patients underwent a brain CT. MRI was performed on 69 percent of TIA patients and 72 percent of stroke patients.
Ultrasound tests, which are important in identifying stroke risk and planning therapeutic interventions, were performed in a much lower percentage of TIA patients than stroke patients. Of the TIA patients, 54 percent underwent carotid Doppler ultrasound compared to 76 percent of stroke patients. Of the TIA patients, 34 percent had echocardiography compared to 60 percent of stroke patients. Transesophageal echocardiography was performed on 1 percent of TIA patients compared to 12 percent of stroke patients, while 5 percent of TIA patients underwent transcranial Doppler compared to 9 percent of stroke patients.
"All the diagnostic tests performed on stroke patients should be performed on TIA patients, because TIA represents a ticking time bomb," Dandapani said.
In the evaluation of therapy, the study found about 60 percent of both TIA and stroke patients were discharged on the antiplatelet agent aspirin. Anticoagulant therapy was similar in both groups. ACE inhibitor therapy was prescribed in 26 percent of stroke patients and in 12 percent of TIA patients.
The rate of documented stroke education at discharge for TIA patients was 35 percent versus 67 percent for stroke patients.
In light of the findings, Dandapani recommended improved public education about TIA and stroke and improved diagnosis and therapy for TIA.
Dandapani plans to extend this TIA research to different regions of the country and to different types of hospitals. A new unit at Holmes Regional Medical Center will meet the needs of TIA patients, she said. All appropriate systems are in place for diagnosis, treatment and education.
Co-authors are James Palermo, M.D.; Todd Schell, OTR/L, M.S.; James Gebel, M.D. and Vijay Vasudevan, a senior at the University of Florida.
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