Stroke experts repeat call to the public not to ignore the symptoms of a TIA or ‘warning stroke’

Stroke experts have once again urged the public not to ignore the symptoms of a Transient Ischaemic Attack (TIA), sometimes referred to as a ‘warning stroke’ or ‘mini-stroke’, because rapid investigations and treatment can prevent a major stroke.

Stroke is one of the leading causes of death and physical disability, and over 7,000 people are hospitalised with stroke in Ireland every year.

Most strokes are called ‘ischaemic strokes’ and are due to a ‘blood clot ‘ which blocks an artery and reduces the blood supply to the brain, eye or spinal cord.

Between 4-30 per cent of ischaemic strokes are preceded by a TIA, which is caused by a shorter, ‘temporary reduction’ in blood supply to these areas of the nervous system; this provides patients and doctors with an extremely important window of opportunity for urgent stroke prevention.

A TIA can cause the exact same symptoms as a stroke, but they do not last as long, usually resolve in minutes and definitely within 24 hours. An easy way to remember the symptoms of a TIA is to remember that it can cause the “S” symptoms, with sudden problems with:

• Sight – blurring or loss of vision or double vision;
• Speech – impaired expression, understanding or slurring;
• Swallowing (less common than with stroke);
• Strength – weakness of the face, arm and/or leg;
• Sensation – usually numbness / reduced feeling and less commonly pins and needles in the face, arm and/or leg;
• Stability – sudden unsteadiness or a sense that you are moving or the environment around you is moving or spinning, called vertigo.

In a letter published in the Irish Times during phase I of the COVID-19 pandemic (Tuesday 05^th May 2020), Professor Dominick McCabe and Dr Allan McCarthy, Consultant Neurologists at Tallaght University Hospital in Dublin, stated that outpatient referrals to their TIA service reduced by up to 80 per cent over a three week period after the start of the COVID-19 pandemic in 2020 compared with a similar period in 2019.

There was also anecdotal evidence of reduced referrals of patients with suspected TIAs to other Hospitals around the Country, mirroring international experience.

According to Professor McCabe, he is once again seeing this concerning trend in early 2021, with fewer people presenting or being referred with symptoms of a TIA, thereby putting their health and life at risk during phase 3 of the COVID-19 pandemic in Ireland.

Prof McCabe and Dr McCarthy advised, “In our own hospital, in collaboration with colleagues in older-adult medicine, vascular surgery, radiology and cardiology, we are maintaining access to expedited outpatient specialised blood tests and neurovascular investigations, with face-to-face assessments in appropriate PPE by a Consultant with expertise in TIA and stroke care to establish an accurate diagnosis and commence urgent treatment to optimally prevent a potentially-disabling stroke on the same day.”

They urged patients with symptoms suggestive of a TIA to make urgent contact with their GP or to attend their local Emergency Department if symptoms occur outside of normal working hours for immediate assessment. GPs or Emergency Department staff can then refer patients for urgent assessment by a stroke specialist at their local hospital if a TIA is suspected.

They advised that with urgent treatment, research has shown that more than 80 per cent of strokes which occur after a TIA can be prevented.

The consultant neurologists emphasized that “the message is to continue to stay safe and to follow all HSE guidelines on COVID-19 regarding social distancing, careful hygiene practices and self-isolation etc., but please do not ignore your symptoms and do not stay at home if you have had a suspected TIA which needs urgent medical assessment and treatment”.