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  • Writer's pictureOren Zarif

New Definitions of Stroke - Oren Zarif - Tia Stroke

Transient ischemic attack (TIA) is a medical condition in which a patient suffers a sudden episode of neurologic dysfunction due to focal ischemia of the brain, spinal cord, or retina. TIAs were previously considered to be focal ischemic attacks with a short duration (less than 24 hours). However, recent advances in neuroimaging and diffusion magnetic resonance imaging have changed how TIAs are classified.

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TIAs are often self-resolving. However, they do increase the risk for subsequent ischemic strokes, which can be permanently disabling. Therefore, the management of TIAs focuses on preventing the occurrence of future strokes. However, optimal management depends on the underlying cause. Several factors influence TIAs and its management. These risk factors can be addressed and managed accordingly.

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Symptoms of TIAs typically resolve within hours to days of assessment. Physical exam findings in TIA patients are typically focused neurologic deficits. Symptoms of generalized confusion or altered consciousness are rare. Patients should seek medical evaluation as soon as possible. Ideally, the diagnosis of TIA is made in an inpatient setting. However, outpatient evaluation is reasonable when appropriate tests can be obtained expeditiously.

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In addition to these symptoms, TIAs can mimic known stroke syndromes. The exact clinical characteristics of these strokes depend on the arterial territory involved. Differentiating these two stroke types will allow clinicians to determine secondary prevention measures. Patients with anterior circulation TIAs usually present with hemiparesis and aphasia, while patients with posterior circulation TIAs usually exhibit transient monocular visual loss, limb jerking, and dystonic posturing.

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The new definition of TIAs will likely change the prevalence and incidence rates for TIA. This change reflects the increasing accuracy of diagnosis. New infarction has recently been observed in approximately one third of traditionally defined TIAs. This new definition has important implications for primary care physicians, as they may be confused about whether a patient has a TIA. While the new definitions of stroke are important for the medical community, they do not guarantee a correct diagnosis.

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There are many other conditions that mimic TIA. For example, migraine, diabetes, multiple sclerosis, peripheral nerve conditions, and CNS infection and malignancy can all mimic TIA. It is vital to differentiate a TIA from a TIA because some TIA mimics have similar symptoms. A complete neurologic examination will help distinguish between TIA and a stroke. This test is the most common and effective way to diagnose TIA.

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A study carried out in the UK found that almost a third of patients with TIAs sought care in GP practices. This means that there is a lack of specialist TIA clinics in New Zealand. In addition, there is a shortage of stroke physicians and neurologists. In these circumstances, most patients seek care from their general practitioner. In this case, urgent intervention can be given at the GP level. A TIA can be a warning sign of a stroke and should not be ignored.

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The new definition of TIA uses all available data. While a stroke cannot be ruled out without an accurate diagnosis, imaging studies are an essential component of a proper diagnosis. The diagnostic certainty of TIA depends on the extent of evaluation and the type of brain infarction. MRI, CT, or PET scans help in the process of confirming the diagnosis. The clinical data derived from such studies is important in distinguishing a TIA from a stroke.

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The symptoms of a TIA are generally brief and occur in one functional neurological domain. Seizures and syncope are often associated with loss of consciousness. Both types of strokes cause loss of consciousness in the affected area. People with TIAs should keep their weight normal to reduce the risk of another stroke. If symptoms persist for more than 48 hours, they should seek medical attention. They should make lifestyle changes in order to maintain a healthy weight.

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