Case summary

An ALS crew was called to a 80s man who was having stroke-like symptoms.  Family called after they stopped by and noticed that the patient was sitting in his truck in his driveway with the door open but had not gotten out.  The patient had left sided weakness and had slurred speech.  Family helped the patient inside and called EMS.  By the time EMS arrived, the patient had complete resolution of his symptoms and the following vitals:

Vitals: HR 68,  BP 126/75,  RR 18,  Sat 98% on RA

Due to his symptoms having resolved, he did not want to go to the hospital.  The crew was concerned about him developing stroke with permanent symptoms in near future and explained this concern to him.  After a short discussion, the patient changed his mind and was agreeable to transport for an expedited stroke assessment.  While in route to the receiving facility, the patient did not develop any new symptoms and remained well.

Highlights of the case:

TIAs increase the risk of a stroke

This patient had transient stroke-like symptoms that completely resolved.  This is consistent with the diagnosis of TIA.  While it is great that the symptoms resolved, he is still at a very high risk of stroke over the next few days.  This is because TIA is identical to stroke in terms of causes.  Some form of clot blocked a cerebral blood vessel causing the patient to develop stroke symptoms.  In the case of a TIA, the clot was broken down by the body before neurons died causing the symptoms to resolve on their own.  If the body was unable to break the clot down, then a stroke would have occurred causing permanent neurologic deficits from neurons dying.  If one clot can form (even if it broke down itself), the underlying cause of the clot is still occurring, so the patient is at high risk for another stroke unless the underlying cause is identified and addressed.  In the setting of a high-risk TIA, 8% of patients can have a stroke in <48 hours from the TIA and 18% can have one in the next 90 days.  For this reason, it is important for patients to be evaluated as soon as possible to potentially prevent the actual stroke.  This crew did a great job advocating for their patient and explaining their concern even though the patient had complete resolution of his symptoms.  Once he realized the risk of stroke over even the next few days, he changed his mind and wanted transport which was in his best interest.