ICH symptoms ‘can mimic TIA’
medwireNews: The symptoms of a minor intracerebral haemorrhage (ICH) can quickly resolve, resembling those of a transient ischaemic attack (TIA), researchers find.
“This study highlights a previously unrecognized presentation of ICH and emphasizes its clinical relevance for patient care”, write Sandeep Kumar (Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA) and study co-authors in JAMA Neurology.
In particular, they say it underscores the need for prompt brain imaging to differentiate between ischaemic and haemorrhagic events.
They note that brain imaging is often delayed in patients with minor symptoms, which “can substantially reduce the sensitivity of detecting a hemorrhage especially beyond a week.” But some of the patients in their study received antiplatelet treatment before undergoing imaging – a potentially hazardous medication in patients with ICH.
Transient ICH symptoms were rare, occurring in just 17 of 2137 patients with spontaneous ICH, although the team believes that the transient and minor nature of the symptoms may mean that some cases do not come to the attention of medical professionals.
Patients’ symptoms were very similar to those seen in TIA patients, with most patients experiencing sensorimotor symptoms such as limb weakness, numbness or loss of coordination. Other symptoms included dysarthria, language impairment, and dizziness with unsteady gait. By contrast, few patients had typical ICH symptoms, such as headache, vomiting and reduced alertness.
The team defined transient symptoms as those resolving within 24 hours, a threshold often adopted to define TIAs. However, they found that “[i]n most patients the improvement started early, usually within several minutes, and the symptoms and signs had resolved well before our adopted time threshold.”
Symptoms resolved in less than 30 minutes in nine patients and less than 6 hours in five patients, while the remaining patient’s symptoms resolved between 12 and 24 hours after onset.
Outcomes during up to 8 months of follow-up were good for all except one patient, who died 4 days later of a recurrent, much larger, haemorrhage.
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