{"id":47251,"date":"2002-11-20T00:00:00","date_gmt":"2002-11-20T06:00:00","guid":{"rendered":"https:\/\/www.unmc.edu\/newsroom\/2002\/11\/20\/unmc-stroke-expert-colleagues-publish-statement-innew-england-journal-of-medicine-recommends-redefinition-of-mini-strokescondition-warrants-immediate-attention\/"},"modified":"2022-08-29T10:46:23","modified_gmt":"2022-08-29T15:46:23","slug":"unmc-stroke-expert-colleagues-publish-statement-innew-england-journal-of-medicine-recommends-redefinition-of-mini-strokescondition-warrants-immediate-attention","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/newsroom\/2002\/11\/20\/unmc-stroke-expert-colleagues-publish-statement-innew-england-journal-of-medicine-recommends-redefinition-of-mini-strokescondition-warrants-immediate-attention\/","title":{"rendered":"UNMC stroke expert, colleagues publish statement in\n\nNew England Journal of Medicine, recommends redefinition of ‘mini-strokes,’\n\ncondition warrants immediate attention"},"content":{"rendered":"

 <\/p>\n

Citing an outdated medical definition of the 1950s and 60s that may<\/p>\n

prevent thousands at risk for stroke from getting appropriate evaluation<\/p>\n

and treatment, a group of eight recognized stroke experts, including a<\/p>\n

University of Nebraska Medical Center neurologist, have recommended a change<\/p>\n

of the definition for transient ischemic attack (TIA). The group has published<\/p>\n

a consensus statement in the Nov. 21 issue of the New England Journal of<\/p>\n

Medicine.<\/p>\n

TIA, also referred to as a mini-stroke or minor stroke, is defined<\/p>\n

by sudden, temporary stroke-like symptoms with no resulting permanent brain<\/p>\n

damage, which last less than 24 hours. Experienced by about 2 million people<\/p>\n

in the United States annually, TIAs are under-recognized, under-reported<\/p>\n

and under-treated and flag persons at high risk for having a stroke, said<\/p>\n

Pierre Fayad, M.D., Reynolds Centennial Professor and chairman of the UNMC<\/p>\n

Department of Neurological Sciences, whos been studying stroke for 14<\/p>\n

years and is part of the eight-member group.<\/p>\n

Dr. Fayad said more than 10 percent of people who experience TIAs develop<\/p>\n

a stroke within the following 90 days, and half of the strokes will happen<\/p>\n

within 48 hours after the TIA. Dr. Fayad said its imperative that patients<\/p>\n

seek immediate treatment for stroke-like symptoms, even if the symptoms<\/p>\n

resolve within the first few minutes or hours.<\/p>\n

When the current definition was created, it stated TIAs will resolve<\/p>\n

in 24 hours, even though there was evidence that most would resolve within<\/p>\n

the first hour, Dr. Fayad said. Other reasons for a redefinition of TIAs<\/p>\n

are sophisticated medical technology, new drugs and greater knowledge of<\/p>\n

TIAs and strokes.<\/p>\n

Not only has the public been conditioned by the definition to wait and<\/p>\n

see if stroke-like symptoms resolve within the current defined 24 hours,<\/p>\n

many health professionals reinforce the idea. Some patients are told to<\/p>\n

watch their symptoms and asked to come to the emergency room only if their<\/p>\n

symptoms do not resolve. Thats a lot of time, Dr. Fayad said.<\/p>\n

We are saying most TIAs will resolve within an hour, but even if someone<\/p>\n

has a TIA, clinically, they may still have stroke resulting in permanent<\/p>\n

damage to the brain, Dr. Fayad said. TIA should be considered exactly<\/p>\n

like a stroke until proven that its not a stroke. Anyone with symptoms<\/p>\n

should come to the ER. The symptoms of whether its a TIA or a stroke should<\/p>\n

be left up to the physician who evaluates them.<\/p>\n

He said TIA is a serious disease thats not being taken seriously enough,<\/p>\n

not only by physicians and the lay public, but also some insurance companies<\/p>\n

that refuse to pay for admissions to the hospital after a TIA, because<\/p>\n

they feel its unnecessary. Evaluating people whove had a TIA and finding<\/p>\n

out the cause is crucial, he said.<\/p>\n

We are much more savvy and now have better tools at preventing and<\/p>\n

treating stroke, Dr. Fayad said. Back then, when the initial definition<\/p>\n

of TIA was crafted, there was no tissue plasminogen activator (tPA), no<\/p>\n

magnetic resonance imaging (MRI), no computerized axial tomographic scan<\/p>\n

(CAT scan) nor magnetic resonance diffusion. In most cases, the only way<\/p>\n

physicians could evaluate stroke was to examine the patient and at most<\/p>\n

do an angiogram.<\/p>\n

The advent of MR diffusion in the last three to four years has added<\/p>\n

fuel to the debate. We know that over half of patients who have a TIA have<\/p>\n

changes on their MRI that suggest stroke. MRI diffusion can tell us within<\/p>\n

minutes where there is a lack of blood flow in the brain. Even for those<\/p>\n

whose TIAs resolve, it may tell us where that lack of blood flow happened,<\/p>\n

whereas initially, all physicians had to rely on was what the patient told<\/p>\n

them.<\/p>\n

Dr. Fayad hopes the consensus statement will trigger a change in attitude<\/p>\n

of health professionals and the lay public, so people having stroke symptoms<\/p>\n

or a brain attack go to the emergency room as soon as possible and not<\/p>\n

wait.<\/p>\n

Stroke is a bad disease because, you can have a heart attack and still<\/p>\n

look normal, Dr. Fayad said. You can have surgery to your belly and still<\/p>\n

look normal. Once you have a stroke, it shows to everyone else around you<\/p>\n

either in minor signs where your face is a little weak or your hand is<\/p>\n

a little weak or in major signs where you are disabled.<\/p>\n

Of the people who’ve had one or more TIAs, its estimated that more<\/p>\n

than a third will later have a stroke, according to the American Heart<\/p>\n

Association. Dr. Fayad said in a recent study, researchers found 15 percent<\/p>\n

of patients who came to the ER with a TIA ended up having a stroke or another<\/p>\n

TIA within the following several weeks.<\/p>\n

TPA, a drug approved by the FDA in 1996, improves the odds of being<\/p>\n

cured from stroke by 30 percent if given within three hours from the onset<\/p>\n

of symptoms. TPA prevents stroke by dissolving clots. Most strokes are<\/p>\n

due to clots.<\/p>\n

It means the patient has to arrive at the emergency room, at most,<\/p>\n

within two hours to be able to receive tPA, which doesnt happen most of<\/p>\n

the time, and this is why tPA is only given in about 2 percent of all patients<\/p>\n

who have stoke in the nation, Dr. Fayad said. You cant give tPA after<\/p>\n

three hours because it increases the risk of complications.<\/p>\n

If the definition of TIA remains the same, then patients would be encouraged<\/p>\n

to stay at home to find out if its going to resolve or not on its own,<\/p>\n

and not come to the ER, and that creates more delay. Unfortunately, by<\/p>\n

the time they realize it did not resolve, and make it to the emergency<\/p>\n

room, it will be too late, and they cannot get treatment.<\/p>\n

Dr. Fayad said it has become imperative to try to avoid confusing patients<\/p>\n

and doctors with arbitrary definitions and making patients wait at home,<\/p>\n

miss a treatment or not be treated appropriately.<\/p>\n

Stroke deprives some people of their independence, he said. You cant<\/p>\n

shop, cant visit friends, cant eat, cant swallow, cant see, cant talk<\/p>\n

and cant speak. It essentially deprives us of most of what defines us<\/p>\n

as human beings.<\/p>\n

Symptoms of a brain attack or TIA are: sudden numbness or weakness<\/p>\n

of the face, arm or leg, especially on one side of the body; sudden confusion,<\/p>\n

trouble speaking or understanding; sudden trouble seeing out of one or<\/p>\n

both eyes; sudden trouble walking, dizziness, loss of balance or coordination;<\/p>\n

and sudden, severe headache with no known cause.<\/p>\n

In 1999, 167,366 people in the United States died from stroke (one in<\/p>\n

every 14.3 deaths in the U.S.) according to the American Heart Association.<\/p>\n

About 47 percent of the deaths occurred outside the hospital. Stroke, the<\/p>\n

leading cause of death behind diseases of the heart and cancer, also is<\/p>\n

the leading cause of serious, long-term disability in the U.S.<\/p>\n

Strokes cause damage to the brain either due to lack of blood flow,<\/p>\n

either from a clot or leakage of blood into the brain. Most who have strokes<\/p>\n

are over age 65 and about 20 percent happen in patients under 55, even<\/p>\n

children. Arteriosclerosis (hardening of the arteries) is one of the main<\/p>\n

causes of stroke, Dr. Fayad said.<\/p>\n

 <\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"

  Citing an outdated medical definition of the 1950s and 60s that may prevent thousands at risk for stroke from getting appropriate evaluation and treatment, a group of eight recognized stroke experts, including a University of Nebraska Medical Center neurologist, have recommended a change of the definition for transient ischemic attack (TIA). The group has […]<\/p>\n","protected":false},"author":79,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-47251","post","type-post","status-publish","format-standard","hentry","category-uncategorized","department-press-release"],"yoast_head":"\nUNMC stroke expert, colleagues publish statement in New England Journal of Medicine, recommends redefinition of 'mini-strokes,' condition warrants immediate attention<\/title>\n<meta name=\"description\" content=\"  Citing an 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