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Opinion
Not just a ‘funny turn’ The symptoms of transient ischaemic attack pass quickly, but should act as a warning for patients, say Caroline Watkins and colleagues ALL NURSES are aware of how important it is for patients with stroke symptoms to receive rapid specialist treatment. However, transient ischaemic attack (TIA), or mini-stroke, is not always viewed as a medical emergency. A report by the Stroke Association on TIA patients’ experiences found that more than one third thought it was a ‘funny turn’. About one quarter of those surveyed agreed that health professionals are too quick to dismiss TIA. Approximately 46,000 people are diagnosed with their first TIA every year, and given how often the condition is overlooked, the Stroke Association estimates that the figure could be much higher. Someone having a TIA may typically experience one or more of the FAST stroke symptoms: facial droop, arm weakness, slurred speech. Less common symptoms may include transient confusion, visual disturbance, vertigo or loss of co-ordination. Typically, TIA has a sudden onset, but unlike stroke, the symptoms are fleeting and last no longer than 24 hours – in fact, they usually resolve within minutes. Risk of stroke Many TIA patients contact their GP surgery or out-of-hours service at symptom onset. Therefore, primary care staff have an important role in identifying TIA symptoms and initiating an emergency response. The greatest risk of having a stroke is within the first few days after a TIA. However, urgent NURSING OLDER PEOPLE
investigation and treatment of people who have a TIA or minor stroke could reduce their risk of having another stroke by 80%. Interventions such as antithrombotic therapy, blood pressure management and, in some cases, carotid endarterectomy, can reduce a TIA patient’s risk of stroke. After treatment, patients should be reviewed by a specialist stroke service at four weeks and again at six months. Secondary prevention measures, including support to make simple lifestyle changes, should continue indefinitely. As well as older age, other risk factors include hypertension, diabetes mellitus, smoking, excess alcohol consumption, obesity and poor diet. However, as with stroke, a TIA can happen to anyone at any time. Nurses working with older people should take a careful history, as TIA symptoms will often have resolved by the time patients seek advice. A family member or other witness may be able to give a clearer history of the event. The patient and family should be advised to call 999 for an ambulance if the TIA/stroke symptoms recur. When a diagnosis has been made, the ABCD2 scoring system, which predicts how soon a patient is at risk of stroke, will aid in decision making about the urgency of referral. High risk patients should be seen at a specialist neurovascular clinic within 24 hours. It is important that staff know when these clinics are available, and can refer patients efficiently. Early specialist assessment is vital. Rapid access TIA clinics
now operate in almost all areas of the UK, and most are accessible seven days a week. Previous research indicates that, despite their transient nature, TIAs can adversely affect quality of life, even if patients do not go on to have a stroke. A number are left with memory loss, vision problems, muscle weakness, poor mobility or confusion months, and sometimes years, after the event. Psychological support TIA can be someone’s first brush with their own mortality and can leave patients feeling shaken and vulnerable. Anxiety, depression and worry about future TIAs and stroke are common. Psychological support and working with patients to address their risk factors may help to alleviate such problems. TIA is commonly referred to as a ‘warning stroke’ – a warning that patients should take seriously and seek emergency medical treatment. Better awareness of TIA and its symptoms among the general public and healthcare professionals could go a long way in reducing the devastating effects of stroke. Caroline Watkins, professor of stroke and older people’s care; Stephanie Jones and Jo Gibson, both research fellows, clincial practice research unit. All at University of Central Lancashire
Find out more May is Action on Stroke Month www.stroke.org.uk/strokemonth May 2014 | Volume 26 | Number 4 11
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Opinion
Not just a ‘funny turn’ The symptoms of transient ischaemic attack pass quickly, but should act as a warning for patients, say Caroline Watkins and colleagues ALL NURSES are aware of how important it is for patients with stroke symptoms to receive rapid specialist treatment. However, transient ischaemic attack (TIA), or mini-stroke, is not always viewed as a medical emergency. A report by the Stroke Association on TIA patients’ experiences found that more than one third thought it was a ‘funny turn’. About one quarter of those surveyed agreed that health professionals are too quick to dismiss TIA. Approximately 46,000 people are diagnosed with their first TIA every year, and given how often the condition is overlooked, the Stroke Association estimates that the figure could be much higher. Someone having a TIA may typically experience one or more of the FAST stroke symptoms: facial droop, arm weakness, slurred speech. Less common symptoms may include transient confusion, visual disturbance, vertigo or loss of co-ordination. Typically, TIA has a sudden onset, but unlike stroke, the symptoms are fleeting and last no longer than 24 hours – in fact, they usually resolve within minutes. Risk of stroke Many TIA patients contact their GP surgery or out-of-hours service at symptom onset. Therefore, primary care staff have an important role in identifying TIA symptoms and initiating an emergency response. The greatest risk of having a stroke is within the first few days after a TIA. However, urgent NURSING OLDER PEOPLE
investigation and treatment of people who have a TIA or minor stroke could reduce their risk of having another stroke by 80%. Interventions such as antithrombotic therapy, blood pressure management and, in some cases, carotid endarterectomy, can reduce a TIA patient’s risk of stroke. After treatment, patients should be reviewed by a specialist stroke service at four weeks and again at six months. Secondary prevention measures, including support to make simple lifestyle changes, should continue indefinitely. As well as older age, other risk factors include hypertension, diabetes mellitus, smoking, excess alcohol consumption, obesity and poor diet. However, as with stroke, a TIA can happen to anyone at any time. Nurses working with older people should take a careful history, as TIA symptoms will often have resolved by the time patients seek advice. A family member or other witness may be able to give a clearer history of the event. The patient and family should be advised to call 999 for an ambulance if the TIA/stroke symptoms recur. When a diagnosis has been made, the ABCD2 scoring system, which predicts how soon a patient is at risk of stroke, will aid in decision making about the urgency of referral. High risk patients should be seen at a specialist neurovascular clinic within 24 hours. It is important that staff know when these clinics are available, and can refer patients efficiently. Early specialist assessment is vital. Rapid access TIA clinics
now operate in almost all areas of the UK, and most are accessible seven days a week. Previous research indicates that, despite their transient nature, TIAs can adversely affect quality of life, even if patients do not go on to have a stroke. A number are left with memory loss, vision problems, muscle weakness, poor mobility or confusion months, and sometimes years, after the event. Psychological support TIA can be someone’s first brush with their own mortality and can leave patients feeling shaken and vulnerable. Anxiety, depression and worry about future TIAs and stroke are common. Psychological support and working with patients to address their risk factors may help to alleviate such problems. TIA is commonly referred to as a ‘warning stroke’ – a warning that patients should take seriously and seek emergency medical treatment. Better awareness of TIA and its symptoms among the general public and healthcare professionals could go a long way in reducing the devastating effects of stroke. Caroline Watkins, professor of stroke and older people’s care; Stephanie Jones and Jo Gibson, both research fellows, clincial practice research unit. All at University of Central Lancashire
Find out more May is Action on Stroke Month www.stroke.org.uk/strokemonth May 2014 | Volume 26 | Number 4 11
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
