TIA (Mini Stroke) Symptoms: A Trip to the ER (cont.)

The symptoms

The doctor advises the woman that there is a need to rush to medical care because if the symptoms do not resolve, there is a very narrow window of time to use alteplase (Activase, TPA), a clot busting drug, to reverse the stroke. Within three hours of the onset of stroke symptoms, the patient needs to get to the hospital, have the initial diagnosis made, have blood tests drawn, a CT scan done to insure that bleeding is not the cause of the stroke, a neurologist needs to be consulted, and the drug given. The earlier the patient is given TPA for stroke, the better the potential outcome and the lower the risk of complications.

A TIA is a stroke that resolves. Most symptoms get better on their own within minutes, but by definition, it may take up to 24 hours for the neurologic deficits to resolve. Because there is no way of knowing when a stroke begins, or whether it will resolve on its own, the EMS system (Emergency Medical Services) or 911 needs to be activated at the first sign of stroke. These symptoms of stroke include:

  • weakness or paralysis on one side of the body,
  • confusion,
  • speech or vision difficulties and
  • due to circulation problems at the base of the brain, loss of coordination and balance and falling without notice.

Unfortunately, many patients do not qualify for TPA because they or their family do not recognize the symptoms of stroke and wait too long at home. The three hour window is very narrow. In some large hospitals, the window can be extended a couple of additional hours, if the hospital has the capability of injecting the drug directly into the blocked artery in the brain. This requires both a radiologist with special skills to thread a catheter or tube into the brain blood vessels and a hospital with the necessary equipment to do the procedure.

The diagnosis

The woman and her husband are reassured after the physical examination that all is well, but the doctor wants to do some testing. And electrocardiogram (EKG) is performed to confirm normal heart rhythms and a CT scan of the brain is done, since small areas of bleeding can also cause stroke and TIA. After these results return as normal, a carotid ultrasound is obtained to ensure that there is no critical narrowing of the carotid artery, which would require surgery.

The doctor sits at the bedside with the woman and her husband and is pleased to tell them that the tests are normal. But plenty of time is spent discussing the potential risks for having a future stroke. While this time, the symptoms resolved, there is no guarantee that future episodes will get better.

Medically Reviewed by a Doctor on 12/1/2014