SP - Stroke

Introduction: Ischaemic stroke has a poor prognosis, and hemorrhagic transformation after intravenous thrombolysis may increase morbidity and mortality in these patients. Methods: By means of a retrospective analysis, related risk factors were recruited for the analyses, including: smoking, alcohol, hyperlipidemia, and diabetes, among others. The statistical analysis was performed by ANOVA for quantitative variables and the Chi-square test for qualitative variables. Results: The study was carried out on 52 patients with acute ischaemic stroke treated with recombinant tissue-type plasminogen activator (rt-PA) within 4.5 hours after symptom onset. Results showed that factors like age ≥70, smoking, atrial fibrillation, NIHSS score before thrombolysis ≥20 and systolic pressure on admission and at 2h after thrombolysis of ≥160mmHg, increased the risk of hemorrhagic transformation after rt-PA administration. Conclusions: Haemorrhagic transformation after thrombolysis is a complication of acute ischaemic stroke. However, a better characterization of Latin American patients will allow us to direct population strategies in these cohorts in a more individualised way, considering that the predictive factors of this event are not entirely clear in different population groups. The aim is to encourage the development of studies of this type in our latitudes in order to reduce the morbimortality of these patients and stratify them appropriately based on their characteristics.

Background and aims: Frailty is a clinical syndrome of increased vulnerability to stressors, associated with adverse outcomes after stroke, but its impact on outcomes after transient ischaemic attack (TIA) remain unclear.

Methods: Retrospective analysis of 1185 patients referred by the emergency department (ED) who attended TIA clinic with a Clinical Frailty Scale (CFS) within two weeks. Records were combined from two routinely collected databases, and prevalence of frailty was determined. Frailty was classified as CFS score >/=4. Data were collected on date of death, and hazard ratios (HR) were determined through cox proportional hazard regression, adjusted for prognostic factors.

Results:  7945 patients were referred through the ED between 01/01/2016 and 12/03/2022. 1185 patients were included. 53.5% (n=634) had frailty. Patients with frailty tended to be older (median age 81 vs 74, p<0.001) and female (53.9% vs 39.9% p<0.001). TIA was diagnosed in 28.3% (n=335), 61.2% (n=205) of whom were frail. Stroke was diagnosed in 23.1% (n=274). 46.7% of these had frailty (n=128). In TIA patients and the whole cohort (WC), frailty (TIA: HR 2.69 [95%CI 1.23-5.87, p=0.013], WC: 2.58 [95%CI 1.64-4.08, p<0.001] ; and increasing age [HR 1.07 95% CI 1.04-1.12], were predictive of mortality. In stroke patients, only increasing age was predictive of death, (HR 1.11 [95%CI 1.04-1.19, p=0.003]).

Conclusions: Frailty is common in TIA and is predictive of mortality. Studies are required to investigate the effects of frailty on other outcomes after TIA, including: quality of life; progression to stroke; and how frailty impacts rehabilitation.

Introduction

Diagnosis of Transient Ischaemic Attack [TIA] is important to minimise risk of future strokes. This retrospective descriptive study aimed to describe frequency of alternative diagnoses in a busy inner-city neurovascular clinic and evaluate processes of assessment and investigations of ‘true’ TIA patients.

Methods

Data was obtained over a 2-year period [2019-2020] for all new patients assessed in a busy consultant-provided daily week-day neurovascular service that serves a million multi-ethnic, population. Data collected included socio-demographic details, final clinical diagnoses, and process measures including speed of assessment and rate of neurological and cardiological investigations.

Results

Of 1764 patients, 39.3% [694] were diagnosed as TIA; 60.7% [1070] had 40 distinct differential diagnoses. Top ten diagnoses included migraine including ocular migraine [9.5%], Syncope [5.5%], Local Eye conditions (non-neurological)[5.3%], non-cervical radiculopathy [4.0%], Benign Paroxysmal Positional Vertigo [4.0%], Previous/Incidental Stroke [3.7%], Transient Global Amnesia [2.4%], Orthostatic Hypotension [1.8%], Non-migraine Headache syndromes [1.6%], Cervical Neuropathy [1.3%]. 10.9%[193] had no organic pathological diagnosis. For 694 TIA patients, 100% had neuroimaging [CT/MRI] and 98% had carotid dopplers on or before day of clinic. Non-urgent cardiovascular investigations performed included echocardiogram [83%], Holter monitoring [75%] and bubble echocardiogram [5%].

Discussion

This large survey has described the frequency of TIA and alternative diagnoses in a dedicated neurovascular service. The study highlights the importance of accurate diagnosis of TIA by experienced clinicians for appropriate secondary prevention. We also described the efficiency, and speed of assessment and proportion of investigations undertaken in these patients. This study provides valuable information to clinicians, researchers and commissioners of stroke services in future.