Residual symptoms and signs are common in TIA diagnosis at first assessment of minor stroke.

Abstract

Background: Transient ischemic attack (TIA) is a heterogeneous emergency department (ED) diagnosis, often including patients with minor stroke. This study aimed to determine the proportion of patients with ischemic stroke admitted to hospital, who had an ED diagnosis of TIA. We aimed to determine their clinical characteristics, the reasons for the revision of the diagnosis to stoke, and the effect of early investigation on secondary prevention treatment. Methods: In this retrospective study we reviewed charts of consecutive patients with a discharge of home diagnosis of ischemic stroke requiring admission of up to seven days between 2009-2012. Demographics, risk factors, medications and ED and neurologist history and physical signs, radiology results, and secondary prevention treatments were extracted. Results: There were 264 patients, 202 (76.5%) with an ED diagnosis of stroke, 37 (14.0%) with a diagnosis of TIA and 25 (9.5% with a non-cerebrovascular diagnoisis of stroke, 37 (14.0%) with a diagnosis of TIA and 25 (9.5%) with a non-cerebrovascular diagnosis in ED. Residual neurological symptoms or signs were present at first assessment in 49% of those with a diagnosis of TIA. MRI with diffusion weighted imaging was performed in 211 (80%). The diagnosis was revised from TIA to stroke based on neurologist assessment, identification of infarction on neuroimaging or a combination of both. In 31% of patients early investigation discovered modifiable risk factors for recurrent stroke, including new inpatient atrial fibrillation in 11 (4%), carotid artery stenosis >50% in 41 (16%), and patent foramen ovale in 28 (11%). Conclusion: Residual symptoms or signs at presentation are common in patients given a diagnosis of TIA in the ED, and are likely indicative of established ischemic stroke rather than TIA in a high percentage of patients. Admission and early investigation of patients with minor stroke can expedite detection of specific stroke aetiologies with major secondary prevention implications.