American Heart Association issues new guidelines for diagnosing 'warning strokes' in ER

Patients who present in the emergency room with signs of a possible transient ischemic attack require in-depth evaluation even if symptoms are no longer present, according to new guidelines issued by the American Heart Association.

The new guidelines, published Jan. 20 in Stroke, offer a standard approach to evaluating possible TIA patients, which can be particularly valuable for hospitals in rural areas where a neurologist may not be on site. 

The AHA recommended viewing TIAs as "warning strokes," noting they often go undiagnosed because symptoms can disappear within an hour — often before patients are seen in emergency rooms. 

A TIA is a strong indicator of a future stroke as "nearly one in five of those who have a TIA will have a full-blown stroke within three months after the TIA, almost half of which will happen within two days," the statement said.

The new guidelines suggest imaging, specifically a noncontrast head CT scan, as part of routine initial assessment in the emergency room, 

following a routine assessment of symptoms. If initial assessments show signs of a TIA, the AHA recommends an MRI within the first 24 hours of the onset of symptoms. 

"About 40 percent of patients presenting in the ER with TIA symptoms will actually be diagnosed with a stroke based on MRI results," the AHA said. 

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