Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label TIA. Show all posts
Showing posts with label TIA. Show all posts

Friday, May 29, 2026

Hospital to pilot test that ‘will save lives’

 Ask your competent? doctor to report back when this is written up in protocol format and delivered AND IMPLEMENTED!

Hospital to pilot test that ‘will save lives’

A rapid stroke test that can show whether a common drug will work is being piloted at a new Nottingham clinic.

The cheek swab test is being offered at Queen’s Medical Centre, where a new clinic is assessing and treating patients after suspected minor stroke.

It can show within hours whether a patient carries a genetic variation that affects how well they respond to clopidogrel, the most commonly used drug to treat strokes.

A stroke affects about 100,000 people a year in the UK and happens when a clot blocks blood supply to part of the brain, potentially causing serious or fatal damage.

The pilot is focused on patients suspected of having a transient ischaemic attack, or TIA, often described as a mini-stroke.

A TIA is caused by a temporary disruption in blood flow to the brain and can be a warning sign of a more serious stroke.

Dr Kailash Krishnan, head of stroke medicine at Nottingham University Hospitals NHS Trust, said: “This rapid test can be done in the hospital while we are carrying out other brain and neck scans, and allows us to make the changes to the patient’s treatment all on the same day.

“We can, therefore, be confident that this test will save lives.

“The results could also have huge ramifications for other treatment the patient is receiving, as medications which may not be working for them because of their genetic variation, can also be adjusted.”

The test may also show whether other medicines are working effectively, including warfarin, some antidepressants, drugs used for anxiety or indigestion, and some statins.

The service, which sees around 200 patients a month, will now offer clinic rooms, greater privacy and a calmer environment, staff said.

The purpose-built clinic is open seven days a week.

The pilot is believed to be the first of its type in the UK.

The test identifies whether a patient has a CYP2C19 gene variation, which affects how the body responds to clopidogrel.

The variation is seen in one in three people nationally, and double that in some ethnic groups.

Nottingham University Hospitals NHS Trust said people with changes in the CYP2C19 gene may not respond properly to clopidogrel and are twice as likely to have further strokes when treated with it.

A test for the gene variation already exists, but results can take up to a week.

Doctors said faster testing is important because TIAs can come before larger and more dangerous strokes.

Rashaad Ashraf Ali had a stroke affecting his right eye in 2024, followed by another in 2025 that damaged his left eye.

Concerns that his medication was not working were confirmed after he took the new test.

He said: “It’s a big relief, actually. You can take the medication, but if it doesn’t work for you, you may end up getting further strokes.

“So, it is a big relief to identify the problem early and be put on new medication, which hopefully will be working in the future.”

Thursday, May 22, 2025

Friday, April 11, 2025

Risk of Recurrent Stroke After TIA or Minor Stroke Is High, 10% of Which May Be Fatal

Well then, create EXACT PROTOCOLS THAT PREVENT THIS PROBLEM! Isn't that the logical solution?

WHY THE FUCK CAN'T YOU PROVIDE THAT?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

Risk of Recurrent Stroke After TIA or Minor Stroke Is High, 10% of Which May Be Fatal

Within 10 years of experiencing a transient ischaemic attack (TIA) or minor stroke, approximately 1 in 5 patients were at risk of having another stroke and 10% of all subsequent stroke events were likely to be fatal, according to a systematic review and meta-analysis published in JAMA.

The annual risk of stroke decreased from 5.9% in the first year to an average of 1.8% per year thereafter. However, the cumulative risk of stroke continued to increase over time. Notably, half of all subsequent strokes occurred after the first year.

“This risk of subsequent stroke events is high but is not readily apparent in routine clinical practice due to its gradual onset over time,” wrote Faizan Khan, PhD, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, and colleagues. “Given that many secondary prevention clinics only monitor patients for the first 90 days, with long-term preventive care often transitioning to primary care physicians and internists, the current findings emphasise the importance of ongoing vigilant monitoring and risk reduction strategies beyond the initial high-risk period.”

The analysis involved 171,068 patients from 38 studies. The patient population consisted of TIA or minor stroke in 17 studies, TIA only in 20 studies, and minor stroke only in 1 study. There were 24 studies that reported the primary outcome of stroke beyond 1 year of follow-up, 12 studies that reported stroke beyond 5 years of follow-up, and 10 studies that reported stroke up to 10 years of follow-up

The pooled rate of stroke per 100 person-years was 5.94 events (38 studies; I2 = 97%) in the first year; 1.80 events (25 studies; I2 = 90%) annually in the second through fifth years; and 1.72 events (12 studies; I2 = 84%) annually in the sixth through tenth years.

Based on an analysis of 32 included studies with data available for the first 90 days, and day 91 through 365 separately, 2,932 of 4,749 (61.7%) subsequent stroke events in the first year occurred within the initial 90 days. The pooled rate of stroke per 100 person-years was 16.09 events in the first 90 days and 3.04 events between 91 and 365 days.

Among the 10 included studies with a maximum follow-up duration of 10 years, 1,707 of 3,390 (50.4%) subsequent stroke events occurred after the first year. The 5- and 10-year cumulative incidences of stroke were 12.5% and 19.8%, respectively.

Based on an analysis of 17 included studies with data available on both fatal stroke (n = 269) and any stroke (n = 2,737), the pooled case-fatality rate of subsequent stroke was 10.4%.

Stroke rates were higher in studies conducted in North America and Asia compared with Europe, in cohorts recruited in or after 2007, and in studies that used active versus passive outcome ascertainment methods. According to the authors, the fact that the risk of subsequent stroke after a TIA or minor stroke appears to have increased in the modern era deserves attention and further research.

“Patients who have had a TIA or minor stroke are at a persistently high risk of experiencing a subsequent stroke,” the authors concluded. “TIA or minor stroke events also portend a significant risk of long-term disability and death. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient population.”

Reference: https://jamanetwork.com/journals/jama/fullarticle/2832005

SOURCE: JAMA

Monday, September 16, 2024

Almost half of patients report the same symptoms one week before a stroke

 Didn't occur to me. I was in the middle of a six day whitewater canoe trip down the Dog River in Ontario, dropping 1150 feet in 23 miles. Some hairy whitewater in fully loaded solo canoes. Swam a few of the rapids.

Almost half of patients report the same symptoms one week before a stroke

Strokes are very scary. Sometimes it can seem like you're fine one minute, and the next things just stop working right. If you know the symptoms of stroke, however, you can actually often see signs before things get really bad. Researchers say that stroke patients report having a mini-stroke one week before. In fact, a study of stroke patients found that 43% of them suffered the same symptoms – a mini-stroke – one week before their stroke. (1)

A Mini Stroke vs. A Stroke

Stroke and mini-stroke are very similar, but there are some differences between the two. A mini-stroke is a small, temporary episode of neurological dysfunction caused by an interruption in blood flow to part of the brain. It is also called a transient ischemic attack, or TIA. A mini-stroke differs from a stroke in two ways: The damage to your brain is not as severe, and it does not last as long. A mini-stroke also has a different cause than a full-blown stroke. A mini-stroke is caused by a temporary blockage in the blood vessels that supply oxygen to your brain. (2)

A regular stroke is a major neurological impairment caused by permanent damage to part of the brain. There are two main types of mini-stroke: An ischemic stroke and a hemorrhagic stroke. In an ischemic stroke, blood flow to part of your brain is interrupted due to a clot in the blood vessels supplying oxygen-rich blood to that area. This type of mini-stroke causes symptoms similar to those of a regular stroke. In a hemorrhagic stroke, a blood vessel in your brain leaks or ruptures and causes bleeding into the surrounding tissues. Stroke is the third leading cause of death in the United States, behind cancer and heart disease. It's also a leading cause of disability among adults ages 65 and older.

Study Shows 43% Of People Have A Mini Stroke Before A Full-Blown stroke

One study showed that 43% of people have a mini-stroke before they experience a full, regular stroke. Many of these people are experiencing the symptoms of this for days or even weeks before they finally go and see a doctor. The risk of having a full stroke is particularly high within the 48-hour window after a mini-stroke. The researchers say, however, that diagnosing mini strokes properly can be difficult, which is why it is important to see a doctor as soon as you can if you think you are having one.

"Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room," said Hardik P. Amin, M.D., chair of the scientific statement writing committee and associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. "There also is variability across the country in the workup that TIA patients may receive. This may be due to geographic factors, limited resources at health care centers or varying levels of comfort and experience among medical professionals."

The Symptoms of Mini Stroke

Mini strokes are much more treatable than a full-blown stroke, which can actually cause permanent brain damage. This is why it is critically important that you are aware of the early symptoms of stroke so you can see a doctor before it's too late. The symptoms of both types of stroke include:

  • Numbness or tingling on one side of your body
  • Weakness on one side of your body
  • Slurred speech or difficulty talking
  • Difficulty seeing out of one eye or both eyes

To remember the symptoms of a full stroke, you can use the acronym FAST:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

Risk Factors For A Stroke

There are several factors that increase your risk of having a stroke. Thankfully, most of them are lifestyle behavior related and can therefore be controlled by you. These factors include:

  • Age
  • Family history of stroke
  • High blood pressure
  • Diabetes or other chronic health problems like kidney disease and heart disease
  • Smoking
  • Obesity (BMI over 30)

The Bottom Line

Strokes are highly dangerous and all too common in the United States. Thankfully, by making healthy lifestyle choices, you can significantly reduce your risk of having one. Knowing the signs and symptoms of both mini-strokes and strokes will also ensure you get the help you need before permanent damage is done. If you think you or someone you know is experiencing the symptoms of a stroke, seek medical attention immediately. It could save a life.

Keep Reading: The Weird and Concerning Reason Human Bones Are Getting More Brittle

Sources

  1. "Stroke symptoms, even if they disappear within an hour, need emergency assessment." Science Daily. American Heart Association. January 19, 2023.
  2. "Ministroke vs. regular stroke: What's the difference?" Mayo Clinic. Jonathan Graff-Radford, M.D.
  3. "43% of stroke patients report the same symptoms 1 week before the event, finds study" Express

The post Almost half of patients report the same symptoms one week before a stroke appeared first on The Hearty Soul.


Tuesday, April 30, 2024

Transient ischaemic attacks: mimics and chameleons

You better hope your doctors can do this because evidence suggests that they're not very good with young adult strokes.

 Transient ischaemic attacks: mimics and chameleons

 

V Nadarajan1,

  1. R J Perry1,
  2. J Johnson1,
  3. D J Werring1,2
  1. Correspondence to Dr David Werring, Reader in Clinical Neurology and Honorary Consultant Neurologist, Stroke Research Group, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; d.werring@ucl.ac.uk

Abstract

Suspected transient ischaemic attack (TIA) is a common diagnostic challenge for physicians in neurology, stroke, general medicine and primary care. It is essential to identify TIAs promptly because of the very high early risk of ischaemic stroke, requiring urgent investigation and preventive treatment. On the other hand, it is also important to identify TIA ‘mimics’, to avoid unnecessary and expensive investigations, incorrect diagnostic labelling and inappropriate long-term prevention treatment. Although the pathophysiology of ischaemic stroke and TIA is identical, and both require rapid and accurate diagnosis, the differential diagnosis differs for TIA owing to the transience of symptoms. For TIA the diagnostic challenge is greater, and the ‘mimic’ rate higher (and more varied), because there is no definitive diagnostic test. TIA heralds a high risk of early ischaemic stroke, and in many cases the stroke can be prevented if the cause is identified, hence the widespread dissemination of guidelines including rapid assessment and risk tools like the ABCD2 score. However, these guidelines do not emphasise the substantial challenges in making the correct diagnosis in patients with transient neurological symptoms. In this article we will mainly consider the common TIA mimics, but also briefly mention the rather less common situations where TIAs can look like something else (‘chameleons’).


 

 

 

 

 

 

 

 

 

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Monday, January 15, 2024

Safety and Feasibility of an Emergency Department–to–Outpatient Pathway for Patients With TIA and Nondisabling Stroke

 Where are the statistics for 100% recovery? No measurement, you'll never get there.

“What's measured, improves.” So said management legend and author Peter F. Drucker 

Safety and Feasibility of an Emergency Department–to–Outpatient Pathway for Patients With TIA and Nondisabling Stroke


  • Abstract

    Background and Objectives

    Evaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging.

    Methods

    As an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as ‘low risk’ through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up. In this prespecified analysis designed to assess feasibility and safety, we abstracted data from patients consecutively enrolled in the first 6 months.

    Results

    We compared data from 106 patients with TIA/NDS enrolled in the new pathway from April through September 2020 (age 67.9 years, 45% female), against 55 unmatched historical controls with TIA encountered from April 2016 through March 2017 (age 68.3 years, 47% female). Both groups had similar median NIHSS scores (pathway and control 0) and ABCD2 scores (pathway and control 3). Pathway-enrolled patients had a 44% decrease in mean ED length of stay (pathway 13.7 hours, control 24.4 hours, p < 0.001) and decreased utilization of ED MRI-based imaging (pathway 63%, control 91%, p < 0.001) and duplicative ED CT plus MRI-based brain and/or vascular imaging (pathway 35%, control 53%, p = 0.04). Among pathway-enrolled patients, 89% were evaluated in our stroke clinic within a median of 5 business days; only 5.5% were lost to follow-up. Both groups had similar 90-day rates of ED revisits (pathway 21%, control 18%, p = 0.84) and recurrent TIA/ischemic stroke (pathway 1%, control 2%, p = 1.0). Recurrent ischemic events among pathway-enrolled patients were attributed to errors in following the safety checklist before discharge.

    Discussion

    Our TIA/NDS pathway, implemented during the initial outbreak of COVID-19, seems feasible and safe, with significant positive impact on ED throughput and ED-based high-cost duplicative imaging. The safety checklist and option of virtual telehealth follow-up are novel features. Broader adoption of such pathways has important implications for value-based health care.

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    Wednesday, June 22, 2022

    70% of ‘mini-stroke’ patients imaged incompletely, risking full-on stroke

    More incompetence in the stroke world, you better hope you're in the 30% category. All because these are  guidelines, NOT PROTOCOLS.

     70% of ‘mini-stroke’ patients imaged incompletely, risking full-on stroke

    Emergency patients diagnosed with transient ischemic attack are supposed to receive, per multiple society guidelines, a complete imaging workup as soon as possible—preferably within 48 hours of ED discharge.

    New national research shows more than two-thirds of TIA patients and, by extension, their treating clinicians, failing to follow through even within 30 days, the maximum recommended window.

    The most concerning risk after TIA, also known as “mini-stroke,” is a subsequent damaging stroke.

    The American Heart Association, American Stroke Association, American College of Radiology and other medical societies call for the ASAP workup protocol in published guidelines, note the authors of the newly published study, which was conducted at University of Colorado Hospital in Aurora and posted online June 17 in JACR.

    To estimate the nationwide rate of guideline adherence, corresponding author Vincent Timpone, MD, and colleagues analyzed Medicare records from more than 6,300 consecutive TIA encounters in emergency departments over a two-year period.

    Defining complete TIA imaging as inclusive of cross-sectional brain, brain-vascular and neck-vascular imaging—either brain MRI or brain CT, plus head and neck CTA, head and neck MRI or carotid ultrasound—the team found 60% of patients (n = 3,804) received the full imaging complement while in the ED.

    However, of 2,542 patients discharged from the ED with incomplete TIA imaging, just 29.9% (761 patients) followed through within the 30-day window.