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Patients Referred for TIA May Still Have Persisting Neurological Deficits

Published online by Cambridge University Press:  02 December 2014

Francois Moreau ,
Thomas Jeerakathil ,
Shelagh B. Coutts  and
FRCPC for the ASPIRE investigators
Francois Moreau
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary
Thomas Jeerakathil
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Shelagh B. Coutts*
Affiliation:
Department of Radiology, University of Calgary, Calgary Department of Hotchkiss Brain Institute, University of Calgary, Calgary
*
Foothills Hospital, C1261, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada.
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Abstract

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Background:

The presence of residual neurological deficits after neurological symptoms is important information for making a diagnosis of Transient Ischemic Attack (TIA) versus stroke. The purpose of this study was to establish the reliability of the referring physician (non neurologist) to report focal neurological deficits in the context of an urgent referral for TIA.

Methods:

Prospectively recorded urgent physician-to-physician phone referrals for TIA through the Southern Alberta TIA hotline from March 2009 to July 2010 were reviewed. “Has the neurological deficit completely resolved?” was asked to the referring physician (family or emergency room physician) and recorded prospectively as a yes/no response. Patients were included if a neurological examination was performed by a neurologist on the same day as referral. The neurologist's assessment of whether the deficit had resolved was compared to that of the referring physician.

Results:

78 patients were included in this study. 62 patients had resolved as per the referring physician's assessment. Of these 62 patients, 16 (25.8% 95%CI 16-38) had evidence of persisting neurological deficits on the neurologist's assessment. A wide variety of mild neurological deficits were identified. None of these deficits appeared to be explained by progression of symptoms.

Conclusion:

Physicians referring patients with TIA syndromes for emergent assessment do not reliably detect mild residual deficits in one-quarter of patients. We are questioning the validity of neurological deficit resolution as a triage rule. The findings suggest that studies of TIA likely include a proportion of minor stroke patients and this should be remembered when extrapolating the results to other populations.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 2 , March 2012 , pp. 170 - 173
Copyright
Copyright © The Canadian Journal of Neurological 2012

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