From the Guidelines
Dysphasia is a significant sign of a transient ischemic attack (TIA) and requires immediate medical attention. Dysphasia, which involves difficulty with language production or comprehension, occurs when there is temporary interruption of blood flow to the language centers of the brain, typically in the left hemisphere. According to the guidelines for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association 1, dysphagia is common after stroke, affecting 42% to 67% of patients within 3 days after stroke. During a TIA, this symptom may last minutes to hours but resolves completely within 24 hours. Other accompanying signs might include facial drooping, arm weakness, slurred speech, confusion, or visual disturbances.
If dysphasia occurs, the person should be taken to an emergency department immediately as TIAs are warning signs of potential future strokes. Initial management typically includes antiplatelet therapy. After the acute phase, patients usually undergo diagnostic testing including brain imaging (CT or MRI), carotid ultrasound, and cardiac monitoring to identify the underlying cause.
- Key considerations in managing dysphasia as a TIA symptom include:
- Early identification and screening for dysphagia to reduce the risk of developing adverse health consequences such as pneumonia, malnutrition, dehydration, weight loss, and overall decreased quality of life 1
- The use of a valid dysphagia screening tool, although no one tool can be recommended 1
- Clinical bedside evaluation to provide valuable diagnostic information about the swallow mechanism and how to proceed with managing the patient 1
- Instrumental evaluation (video fluoroscopy, fiberoptic endoscopic evaluation of swallowing, or fiberoptic endoscopic evaluation of swallowing with sensory testing) for more sensitive assessment 1
- Early tube feeding (started within 7 days) to increase the survival of dysphagic patients who cannot safely eat by mouth, with the option to wait up to 7 days after a stroke to initiate tube feeds 1
Risk factor modification is essential following a TIA, including blood pressure control, cholesterol management, diabetes control, smoking cessation, and lifestyle modifications. The urgency in addressing dysphasia as a TIA symptom stems from the fact that approximately 10-15% of patients who experience a TIA will have a full stroke within three months, with half of these occurring within 48 hours of the TIA.
From the Research
Dysphasia as a Sign of Transient Ischemic Attack
- Dysphasia, also known as aphasia, is a symptom that can be associated with transient ischemic attack (TIA) 2.
- According to the study published in Cerebrovascular Diseases, isolated aphasia is an independent sign of atrial fibrillation (AF) in patients with TIA or minor ischemic stroke 2.
- The study found that patients with isolated aphasia were more likely to have AF, and that careful cardiac screening is warranted in these patients 2.
- Other studies have also highlighted the importance of early diagnosis and treatment of TIA, as it can significantly reduce the risk of future stroke 3, 4, 5, 6.
- Common symptoms of TIA include sudden and transient unilateral paresis, speech disturbance, and monocular blindness 4.
- The ABCD(2) score can be used to assess the immediate risk of repeat ischemia and stroke in patients with TIA 4.
- Imaging of the brain and intracranial and extracranial blood vessels is an important part of the diagnostic assessment for TIA 6.
- Treatment options for TIA include anticoagulation for atrial fibrillation, carotid revascularization for symptomatic carotid artery stenosis, antiplatelet therapy, and vascular risk factor reduction strategies 6.