Neurologists call for elimination of TIA as diagnosis

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Neurologists call for elimination of TIA as diagnosis

Last Updated: 2004-02-06 16:44:38 -0400 (Reuters Health)

By Martha Kerr

SAN DIEGO (Reuters Health) - A panel of neurologists presenting data

here on transient ischemic attacks (TIAs) asserted on Friday that the

diagnosis is misleading and can lead to the mismanagement of patients.

These patients should all be considered stroke patients, they agreed.

Dr. S. Claiborne ston of the University of California at San

Francisco told attendees of the American Stroke Association's 29th

International Stroke Conference that 24-hour hospitalization of TIA

patients is cost-effective, since the risk of stroke during that time

period is so high in these patients.

The UCSF team analyzed the incremental cost of care for 24 hours of

hospitalization of TIA patients evaluated in the emergency departments

of 11 San Francisco Bay Area hospitals. They found that if patients were

admitted, a new stroke could be identified within the first hour of

onset and they could receive thrombolysis early in the therapeutic

window. The result would be a minimization of sequelae and a shorter

length of stay than patients sent home after resolution of TIA symptoms.

The net cost would be $44,000 per quality of life years per patient if

the TIA patient is admitted. " This is well within the range of what is

considered cost-effective, not even considering the other benefits, such

as a rapid work-up, " Dr. ston said.

In a second study, the UCSF group found that the risk of stroke after

first hospitalization for TIA was 5.6% in the first 48 hours and 11% at

90 days, Dr. ston said. Stroke incidence after TIA was 16.3% at 3

months, 18.4% at 6 months, 21.4% at one year and at 3 years 21.2%.

" These numbers...are higher than previously published because all of

these patents were hospitalized, " Dr. ston noted. " As you can see,

TIAs are not benign. "

" These [stroke] events are front-loaded, " panel moderator Dr.

of the Medical College of Georgia at Augusta pointed out. " The

[stroke] activity is much higher during the first 48 hours than during

the first 60 days...These patients need to be kept in the system. We

need to follow-up during the first 24 hours to determine the cause of

the TIA. The patient needs a [neurological] work-up and referral for

special consultation. "

" I would admit every patient with TIA to the hospital, " said Dr. Orell

Mielke of Neurologische Universitatsklinik of Klinikum Mannheim in

Germany. He presented results of a 6-month follow-up of 1380 TIA

patients and 3850 ischemic stroke patients.

At the end of 6 months, 6.2% of TIA patients had died compared with

16.2% of stroke patients. Twenty-two percent of TIA patients were

dependent compared with 41% of stroke patients. Risk of stroke during

follow-up was almost the same in TIA patients and stroke patients-6.0%

and 8.4%, respectively.

" It makes no sense to separate TIA from stroke, " Dr. Mielke asserted.

" TIAs and strokes are both accidents in the progression of the same

disease. " Drs. and ston concurred. All three believe TIA is

misleading as a diagnosis. Patients and many clinicians may be lulled

into a sense of complacency when TIA symptoms disappear, the panelists

said.

" In fact, even though it sounds counterintuitive, TIA patients have an

increased risk of deterioration and poor recovery with a stroke than

stroke patients, " Dr. ston told Reuters Health.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org