"crptogenic stroke"

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MROCCDOC

"crptogenic stroke"

Post by MROCCDOC » Thu Sep 20, 2018 2:56 pm

I have a 57 yo fellow who had a "cryptogenic stroke" March 2017. Had left sided paresthesias and L LE ataxia on presentation. Hospital called a stroke alert and gave him tPA and his symptoms resolved. HIs imaging did not show any defects (MRI, CT and angio). He has some mild carotid plaque. He never had a follow up CDME back then and returned to driving CMV with a note. Comes back now for his recert and I find all this out. He is cleared to drive by his neurologist and cardiologist, had no seizures or syncope and is noted to have a ">1% chance of recurrence." PMH high cholesterol diet controlled. Only taking aspirin. On exam, he is normal, BMI 26. No neuro residuals. Does he get a card? Does he have a waiting period? If he had a ACA/MCA stroke, guidance is to wait 5 years... If he had a TIA, suggested wait is 1 yr... It's been 1.5 years now... Thanks for the feedback



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Re: "Cryptogenic stroke"

Post by Robert Swotinsky MD » Thu Sep 20, 2018 3:44 pm

A transient ischemic attack (TIA) used to be defined as stroke-like symptoms that resolve within 24 hours. More recently, the distinction between TIA v. stroke has been based on the presence of tissue damage - if present, it was a stroke.

In the case as described, it appears there was no identified tissue damage and no residual deficits. If the residual deficits cleared within 24 hours, then the case meets both the old and new criteria for a TIA. I'd clear him based on hx of TIA, being beyond the 1 year wait period, and the neurologist's clearance.

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