Clinical diagnosis of TIA or minor stroke and prognosis in patients with neurological symptoms: A rapid access clinic cohort

Abstract

BackgroundThe long-term risk of stroke or myocardial infarction (MI) in patients with minor neurological symptoms who are not clinically diagnosed with transient ischaemic attack (TIA) or minor stroke is uncertain.MethodsWe used data from a rapid access clinic for patients with suspected TIA or minor stroke and follow-up from four overlapping data sources for a diagnosis of ischaemic or haemorrhagic stroke, MI, major haemorrhage and death. We identified patients with and without a clinical diagnosis of TIA or minor stroke. We estimated hazard ratios of stroke, MI, major haemorrhage and death in early and late time periods.Results5,997 patients were seen from 2005–2013, who were diagnosed with TIA or minor stroke (n = 3604, 60%) or with other diagnoses (n = 2392, 40%). By 5 years the proportion of patients who had a subsequent ischaemic stroke or MI, in patients with a clinical diagnosis of minor stroke or TIA was 19% [95% confidence interval (CI): 17–20%], and in patients with other diagnoses was 10% (95%CI: 8–15%). Patients with clinical diagnosis of TIA or minor stroke had three times the hazard of stroke or MI compared to patients with other diagnoses [hazard ratio (HR)2.83 95%CI:2.13–3.76, adjusted age and sex] by 90 days post-event; however from 90 days to end of follow up, this difference was attenuated (HR 1.52, 95%CI:1.25–1.86). Older patients and those who had a history of vascular disease had a high risk of stroke or MI, whether or not they were diagnosed with minor stroke or TIA.ConclusionsCareful attention to vascular risk factors in patients presenting with transient or minor neurological symptoms not thought to be due to stroke or TIA is justified, particularly those who are older or have a history of vascular disease.

Clinical Diagnosis and Magnetic Resonance Imaging in Patients With Transient and Minor Neurological Symptoms: A Prospective Cohort Study

“…Despite this, clinical diagnosis of TIA or stroke is moderately predictive of stroke recurrence in patients presenting to TIA services, even in the absence of brain imaging. 17 This could improve with a structured proforma for focal symptoms, given that the proportion of people with a DWI lesion was higher in patients with a National Institute of Neurological Disorders and Stroke defined TIA or minor stroke in this study.…”

“…Compared with all patients arriving at the clinic, these participants were younger (60 versus 69 years) although the distribution of sex and symptoms were similar. 17 We did not assess further nonconsenting patients. Second, we did not follow every participant up to 24 hours after their onset of symptoms to determine the speed of symptom resolution, and so we could not make a reliable time-defined TIA diagnosis.…”

Evaluation of microalbuminuria as a prognostic indicator after a TIA or minor stroke in an outpatient setting: the prognostic role of microalbuminuria in TIA evolution (ProMOTE) study

“…There is no consensus on the gold standard for diagnosing TIA in a rapid access stroke clinic. 43 In order to maintain the generalisability of the study, all attendees of the stroke clinic that were diagnosed with a probable or definite TIA were invited to participate. Only a small number of patients were subsequently withdrawn as being stroke mimics.…”

Headache associated with intracranial hypotension: diagnostic challenges and difficulties in everyday neurological practice

“…Due to the disease's varied symptomatology and possible sudden onset, SIH-related headaches may also be misdiagnosed as headaches during TIA or even stroke [24]. Symptoms of SIH that may direct the diagnosis towards cerebrovascular diseases include dizziness, balance disorders, numbness or paresthesia of the face or limbs, vision and hearing disorders, taste disorders, and abducens nerve palsy [25,26]. From a practical point of view, the most helpful tool in verifying the diagnosis will be a head MRI (with contrast).…”