Sebina Bulic, MD

TIA is the golden opportunity for the aggressive work up and stroke risk reduction in symptomatic patients and should represent neurologic urgency.



In this study from Japan, data was collected from 13 stroke centers and retrospectively analyzed.  Four hundred and twenty one patients with TIA within 7 days were dichotomized in the following 5 categories: <3 hours, 3-6 hours, 7-12 hours, 13-24 hours and >24 hours. Factors associated with the time from symptom onset to arrival at a stroke center were assessed.

Motor weakness, speech disturbance, and duration of symptoms > 10 minutes were
independently associated with a shorter onset to door time. Interestingly a history of TIA and hypertension, and a referral from another medical facility were  independently associated with a longer onset to door time. Onset to door time and stroke during the acute admission, which was the primary outcome did not have relationship.

Patient population and healthcare delivery system in Japan is very different from the United States, thus I don’t know if results of this study would be applicable here. What I found interesting was that a history of TIA and hypertension were  independently associated with a longer onset to door time. I would have never assumed that, and this is worrisome for me. Do we really provide such poor education to our at risk population?