national-clinical-guidelines-for-stroke-fourth-edition

1.4.1 Duration of cerebrovascular events
The distinction between stroke and TIA is based simply on the duration of symptoms.
However, it is not a useful or sustainable distinction.
The reasons for not distinguishing stroke from traditionally defined TIAs include:
> evidence that some people with transient symptoms nonetheless have cerebral
infarction or haemorrhage
> a similar natural history in terms of further episodes of cerebral and non-cerebral
vascular events
> a similar clinical need for people with mild and short-lived stroke as for people with
TIA
> the logical impossibility of knowing the distinction within the first few hours, the
precise time when decisions on acute treatment need to be made.
Despite these issues we have chosen to address the conditions separately as the research
evidence usually separates them. We do however wish to stress that nearly always what is
appropriate for non-disabling stroke is also appropriate for TIA.
1.4.2 Resolved neurovascular events
Three facts must be recognised:
First, there are patients who have neurological symptoms secondary to vascular disease
lasting only a very short time. Clinically most recover in about 1 hour or less.
Second, there will inevitably be patients who first present to health services later after
onset (within a few days) and have few or no residual symptoms. They have events that
recover quickly if not completely but the events still need diagnosis and management.
Last, there will be patients who recover more or less completely from their stroke within a
few days without any specific treatment. They may have a few symptoms, but have no
appreciable limitation on normal daily activities.
All of these patients have had resolved neurovascular events and all remain at risk of
further vascular episodes, and should be managed in a similar way.
1.5 Context and use
1 Introduction
A guideline cannot cover every eventuality, and new evidence is published every day so
parts of the guideline will become out of date. Thus the recommendations should be
taken as statements that inform the clinician or other user, not as rigid rules. The
clinician is responsible for interpreting recommendations, taking into account the
specific circumstances being considered, and for considering whether new evidence
might exist that would alter the recommendation.
This guideline relates to the aspects of management that are specific to stroke; it does
not specifically cover areas of routine good clinical practice such as courtesy, managing
associated illness, and accurate record keeping. It is assumed that this guideline will be
used within the context of the services available in the UK, and that clinicians and others
will be operating within professionally recognised standards of practice.
© Royal College of Physicians 2012 5