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How is a mini stroke diagnosed?

Women are less likely than men to be diagnosed with minor stroke

Study encourages doctors to look beyond typical symptoms for stroke

Date: May 23, 2019 Source: University of Calgary Summary: A new study find women experiencing a minor stroke or transient ischemic attack (TIA) are less likely to be diagnosed with a stroke compared to men — even though they describe similar symptoms in emergency departments. Share:


Women experiencing a minor stroke or transient ischemic attack (TIA) are less likely to be diagnosed with a stroke compared to men — even though they describe similar symptoms in emergency departments.

«In our study, men were more likely to be diagnosed with TIA or minor stroke, and women were 10 per cent more likely to be given a non-stroke diagnosis, for example migraine or vertigo, even though men and women were equally likely to report atypical stroke symptoms,» says study lead author Dr. Amy Yu, MD, a stroke neurologist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto.

The findings of the study are published in JAMA Neurology and were presented May 22 at the European Stroke Organisation Conference in Milan, Italy.

The study found men and women equally described atypical stroke symptoms such as dizziness, tingling or confusion which are not commonly thought of as related to stroke. Typical symptoms of stroke are sudden weakness, face drooping, or speech difficulties.

A TIA occurs when there is temporary interruption of blood flow to the brain, and is often a warning sign of another stroke. TIAs can also be associated with permanent disability.

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Discrepancy in diagnoses

«Our study also found the chance of having another stroke or heart attack within 90 days of the diagnosis was the same for women and men,» adds senior author Dr. Shelagh Coutts, MD, a stroke neurologist with Alberta Health Services at Foothills Medical Centre, associate professor at the University of Calgary’s Cumming School of Medicine (CSM) and member of the Hotchkiss Brain Institute at the CSM.

Researchers say while further research is needed, it is possible that patient reporting of symptoms, interpretation of symptoms by clinicians, or a combination of both, could explain the discrepancy in diagnosis among men and women.

«Our findings call attention to potential missed opportunities for prevention of stroke and other adverse vascular events such as heart attack or death in women,» adds Coutts.

Previous studies on this topic have focused on patients diagnosed with stroke. Researchers in the current study included 1,648 patients with suspected TIA who were referred to a neurologist after receiving emergency care from 2013-2017, regardless of their final diagnosis.

Spotlight on atypical symptoms

Researchers note it is an important opportunity for the public and clinicians to be aware of atypical symptoms of TIA.

«What’s important to recognize in stroke is that the brain has so many different functions and when a stroke is happening, people can feel different things beyond the typical stroke symptoms,» says Yu. «Accurately diagnosing TIA and stroke would change a patient’s treatment plan and could help prevent another stroke from happening.»

Funding for the study was provided by Genome Canada, Genome B.C., Genome Alberta, and the Heart and Stroke Foundation of Canada.

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        What is a transient ischemic attack (TIA)?

        A transient ischemic attack (TIA), or ministroke, results from a temporary stoppage in the blood supply to the brain. The symptoms are similar to those of a stroke. TIAs usually last 5 minutes at most but can be a sign of a major stroke to follow. A TIA is a medical emergency.

        Many people do not seek help for a TIA because the symptoms pass quickly. However, the Centers for Disease Control and Prevention (CDC) note that more than one-third of people who do not receive treatment for a TIA have a major stroke within a year.

        Additional statistics suggest that 20% of those who have a TIA have a stroke within 3 months, and half of these will happen within 2 days of the TIA.

        Knowing the symptoms of a TIA and getting help quickly may help prevent a more severe and possibly life threatening event.

        In this article, learn more about what a TIA involves and which action to take if one occurs.

        A TIA causes similar symptoms to those of a stroke, but it is temporary. The reduced blood supply usually only lasts for a few seconds, and the symptoms tend to last for minutes. Rarely, they can last for up to a few hours.

        TIAs occur when a blood clot blocks blood flow and prevents oxygen from reaching the brain cells for a short while. When the clot breaks up or moves on, the symptoms tend to resolve. These events do not last long enough to cause permanent damage to brain cells.

        The American Stroke Association urge people not to ignore a TIA, as it can be a warning sign for a major stroke.

        Statistics suggest that TIAs affect around 2% of the population of the United States.

        The symptoms of a TIA will depend on which part of the brain is not receiving adequate blood flow.

        As with a major stroke, the acronym FAST (face, arms, speech, time) can help people remember the symptoms to look for:

        • F = face: The eye or mouth may droop on one side, and the person may be unable to smile properly.
        • A = arms: Arm weakness or numbness might make it hard to raise one or both arms or keep them raised.
        • S = speech: The person’s speech may be slurred and garbled.
        • T = time: Someone should call the emergency services at once if a person has one or more of these symptoms.
        • numbness or weakness, especially on one side of the body
        • sudden confusion
        • difficulty understanding what others are talking about
        • vision problems
        • dizziness
        • problems with coordination
        • difficulty walking
        • a very bad headache
        • a loss of consciousness, in some cases

        TIA symptoms are temporary. They can last for a few minutes to a few hours, and they usually disappear completely after 24 hours.

        However, it is essential to seek medical help at once if anyone has symptoms that may indicate a TIA because a major stroke may follow.

        The same factors that lead to the temporary insufficiency of blood flow in a TIA can cause a stroke due to longer lasting blood flow reduction, which can lead to permanent brain damage.

        Conditions with similar symptoms

        The symptoms of a TIA can resemble those of other conditions, such as :

        • meningitis
        • multiple sclerosis
        • a hemorrhagic stroke or ischemic stroke
        • fainting due to low blood pressure

        Getting an accurate diagnosis can help a person access the right treatment to help lower the risk of a future stroke, even if the symptoms of the TIA have already passed.

        How is a mini stroke diagnosed?

        be fast stroke graphic illustrates the warning signs of stroke

        A transient ischemic attack (TIA), also called a mini-stroke, is a disturbance in brain function caused by a temporary blockage of blood to the brain. The symptoms of a TIA are the same as those of an ischemic stroke, but TIAs do not result in lasting brain damage. The blockage causing the TIA becomes dislodged or is dissolved by natural clot dissolvers in the blood, called anticoagulants, and blood flow to the brain is restored before any permanent damage occurs. A TIA is also called a “warning stroke” because about a third of the people who have a TIA have a more severe stroke within a year. Taking steps to prevent a stroke is an important way to respond to a TIA. Even though a TIA may resolve within minutes, anyone who has stroke-like symptoms should dial 9-1-1 immediately. It is never safe to assume symptoms will resolve on their own. Recognizing a stroke quickly and calling 9-1-1 leads to faster diagnosis and treatment and better recovery. People should “BE FAST” when it comes to stroke. Here’s how to BE FAST:

        • B – BALANCE: Ask the person to walk. Do they have trouble keeping their balance or walking normally?
        • E – EYES: Ask the person about their eyesight. Have they lost vision or experienced vision changes in one or both eyes?
        • F – FACE: Ask the person to smile. Does one side of the face droop?
        • A – ARMS: Ask the person to raise both arms. Does one arm drift downward?
        • S – SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
        • T – TIME: If you observe any of these signs, call 9-1-1 immediately.

        Transient Ischemic Attack (TIA) Symptoms

        The signs of an ischemic stroke depend on the side of the brain that is affected, the part of the brain affected, and how long the brain has been deprived of blood. Therefore, each person may have different stroke warning signs.

        The most common symptom of a transient ischemic attack (TIA) or ischemic stroke is sudden weakness of the face, arm, or leg, usually on one side of the body.

        Symptoms of TIA may include:

        • Blindness in one or both eyes
        • Difficulty speaking (for example, slurred speech)
        • Dizziness and vertigo
        • Double vision
        • Generalized weakness on both sides of the body
        • Impaired consciousness (such as confusion)
        • Loss of coordination
        • Seizure
        • Sudden numbness or weakness of face, arm or leg, especially on one side of the body
        • Urinary incontinence

        Stroke is a medical emergency. If you or someone you know has these symptoms, call 9-1-1 and seek medical attention immediately.

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