Proceedings of the Texas A&M Medical Student Grand Rounds

Treatment and Prevention of TIAs to Prevent Further Attacks and Ischemia

June 25, 2024 Claudia Kramer

Claudia Kramer

Background: Transient Ischemic Attacks (TIAs) are a serious medical condition with a significant risk of subsequent stroke. Despite their importance, TIAs are often underrecognized due to their transient nature and similarity to other conditions. Various screening methods have been explored to improve TIA recognition. This project reviews the efficacy of these methods and explores avenues for enhancing stroke recognition in the pre-hospital setting.

Methods: This research was done primarily through the Texas A&M library using the PubMed data base. The search was initiated using the MeSH database and searching for “transient ischemic attack” to find background and review articles on the topic. Then, the MeSH subheading “prevention and control” was selected to focus on papers that addressed prevention and education. Search results were limited to review articles or peer-reviewed studies published in the past 5 years.

Results: Education campaigns targeting both the public and healthcare providers have shown promise in increasing awareness and improving recognition rates. Paramedic training on simple tests like the finger-to-nose (FTN) test has demonstrated a 30% improvement in identifying posterior strokes. Additionally, modifying dispatcher protocols and community education can lead to more accurate symptom recognition and faster EMS response times. A support program for patients post-TIA or stroke has shown positive effects on adherence to secondary prevention measures, though its impact on recurrence rates remains to be fully established.

Conclusions: Since these studies were able to correlate better clinical outcomes with informational campaigns, they demonstrate the benefit of awareness and education in the pre-hospital setting. Many of the articles reviewed concluded by stating that the area of research is “promising, but needs to be expanded”, indicating a lot of room for future studies. The successful integration of a variety of screening methods in the prehospital setting demonstrates a tangible step forward in stroke recognition, underscoring the potential for targeted educational interventions to enhance early diagnosis and improve outcomes in stroke care.

Works Cited

  1. Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S, Burrus TM, Panagos PD, Wintermark M, et al. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke. 2023;54:e109-e121. doi:10.1161/STR.0000000000000418
  2. Mendelson SJ, Prabhakaran S. Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review. JAMA. 2021;325(11):1088–1098. doi:10.1001/jama.2020.26867
  3. Jeffrey J. Perry, Krishan Yadav, Shahbaz Syed and Michel Shamy. Transient Ischemic Attack and Minor Stroke: Diagnosis and Management, CMAJ October 11, 2022 194 (39) E1344-E1349; DOI: https://doi-org.srv-proxy2.library.tamu.edu/10.1503/cmaj.220344
  4. Benjamin Clissold, Thanh G. Phan, John Ly, Shaloo Singhal, Velandai Srikanth, Henry Ma, Current aspects of TIA management, Journal of Clinical Neuroscience, Volume 72, 2020, Pages 20-25, ISSN 0967-5868, https://doi.org/10.1016/j.jocn.2019.12.032.
  5. Haesebaert J, Laude C, Termoz A, et al. Impact of a theory-informed and user-centered stroke information campaign on the public’s behaviors, attitudes, and knowledge when facing acute stroke: a controlled before-and-after study. BMC Public Health. 2020;20(1):1712. Published 2020 Nov 16. doi:10.1186/s12889-020-09795-y
  6. Oostema JA, Chassee T, Baer W, Edberg A, Reeves MJ. Educating Paramedics on the Finger-to-Nose Test Improves Recognition of Posterior Stroke. Stroke. 2019;50(10):2941-2943. doi:10.1161/STROKEAHA.119.026221
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  8. Ahmadi M, Laumeier I, Ihl T, Steinicke M, Ferse C, Endres M, Grau A, Hastrup S, Poppert H, Palm F, Schoene M, Seifert CL, Kandil FI, Weber JE, von Weitzel-Mudersbach P, Wimmer MLJ, Algra A, Amarenco P, Greving JP, Busse O, Köhler F, Marx P, Audebert HJA. A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial. Lancet Neurol. 2020;19(1):49-60. doi:10.1016/S1474-4422(19)30369-2.
  9. Chehregani Rad I, Azimi A. Recognition of Stroke in the Emergency Room (ROSIER) Scale in Identifying Strokes and Transient Ischemic Attacks (TIAs); a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2023 Oct 5;11(1):e67. doi: 10.22037/aaem.v11i1.2135. PMID: 37840869; PMCID: PMC10568950.
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