Difference between TIA and Ischaemic Stroke?

My brother aged 55 has just had a stroke with a blood clot and left brain damage. He has loss of vision a ‘Complete Right Homonymous Hemianopia’.

He was admitted on a Saturday 15 March and discharged 3 days later (Monday 17 March). His discharge notification stated: "No follow up - None Planned.

On Monday 17 March after lunch we had to insist that we speak with the consultant looking after him as at this point the consultant nor any doctor had even spoken with the family.

He was bumping into the door fames in the hospital when he was discharged on the Monday 17 March. I had to learn to walk on his right side, as I am new to all of this myself.

The family’s understanding is that a blood clot with ongoing vision loss is an Ischaemic stroke not a TIA. We can’t seem to get clarity from the hospital of the definition of the type of stroke he has had or cause. My brother had been told he would get an MRI but this was cancelled even though as next of kin I requested this be done in the meeting with the consultant.

After he was discharged we rang the stroke ward and we asked why there was no follow up but we didn’t get a response after leaving a voicemail for the consultant’s assistant, so we rang again a week later and now have a follow up appointment tomorrow with the ‘Stroke Clinal Lead’ - but his letter says ‘TIA clinic’. We were told that the consultant looking after him was now on annual leave.

We don’t understand why my brother didn’t have a follow up appointment with none planned either but now has a ‘follow up’ appointment in less than three weeks with the ‘Stroke Clinical Lead’? Surely this is too soon for a follow up appointment. Normally it is around 6 weeks to see what progress has been made.

We were with my brother when he was sent to the discharge lounge - the consultant looking after him didn’t even tell us they were discharging him suddenly that afternoon following this meeting. .

He was given medications of 300mg Aspirin/Lansoprazole up to 28 March and on 29 March to start 75mg Clopidogrel. No nurse or doctor explained the drugs to him or to us. We have had to check these drugs ourselves and any contraindications.

Previous medical history. 3 years ago had severe pneumonia with ARDS and was intubated and put in a medical coma for 2 months/leaking tracheostomy causing a severe bacterial infection. He still has breathing issues as he still has damage to his lungs - though this has improved greatly but he can still get fatigued and breathless at times.

Has anyone experienced a similar discharge with no follow- up and none planned? Is the family correct this is in fact an Ischaemic Stroke as his symptoms are ‘ongoing’ with ‘significant vision loss’ and a clot with brain damage, not a TIA - which are transient and short lasting?

Appreciate any advice help as never had a family member who have had a stroke before.

Many thanks.

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You may want to speak to the stroke helpline for a more detailed answer 0303 3033 100.

You can also email them

A TIA and a stroke are the same thing in essence. The blood supply to part of the brain gets blocked off, either by a fatty deposit or blood clot.

Anything beyond that point can’t get the oxygen or nutrients and the brain cells begin to get damaged and die. This is what presents as the symptoms in a stroke.

In a TIA this blockage is temporary and the blockage resolves itself. Most TIA’s have symptoms that last for a couple of mins.

If the blockage does not move, the symptoms persist and you require treatment urgently to attempt to treat it. Which is why your advised to call 999 asap.

If your symptoms go, or resolve within 2 days, they class it as aTIA, if you still have effects you have had a stroke (by medical definition)

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Welcome to the complex and often confusing world of stroke!

Unfortunately your NHS treatment is entirely a postcode lottery. Some services are great… others not so much.

As far as I am aware a TIA clinic will deal with ‘minor’ ischemic (or ‘full’) strokes as well. So that should explain why the letter said that.

Some doctors (in the US specifically) seem a bit more likely to diagnose as a TIA rather than a stroke, as they see them as ‘minor’ events. Here in the UK, they’re a bit more strict with the diagnosis. TIA should have no lasting physical symptoms (though fatigue etc is common for a long time after).

MRI is the only way to clinically diagnose one or the other. A stroke will leave visible brain damage. A TIA will not. That’s a very simplistic explanation.
I personally had 3 MRIs, months apart. All showed brain damage unfortunately.

It sounds like you are already pushing for better care and that in some cases is what we have to do - be our own advocates for health services. You have the right to request a different consultant too for your brother.

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@AlwaysHope Hi & welcome to the community. Sorry to hear of your brother’s stroke & what appears to be a lack of follow on care. As others have said follow on care seems to be very much a postcode lottery. Some people get follow ups others don’t. Even though the appointment you have feels like it is too soon for you please do attend. A TIA clinic & stroke review appointment are pretty much the same thing & you’d probably see the sqme person. Make sure you have all your questions ready in advance. You might want to ask for an MRI, why there’s no follow up planned. I would expect at least a referral to ophthalmology given his vision issues. Also you might want more tests to find out the reason for the stroke if that isn’t already known. Usually a lot of wha you have mentiones would appear in a discharge letter.

Usually a TIA is transient i.e. symptoma resolve quickly whereas a stroke leaves laating effects and as @matt_d13 has said a stroke will show brain damage on a scan.

The change of meds from aspirin to clopidogrel is standard following a stroke & I would hope that they know what meds your brother is already on so any contraindications will have been taken into account. Always qorth checking though. It may be they have been talking this through with your brother & he’s got a bit muddled given that he has had a stroke.

Best wishes

Ann

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