Non-Focal Neurological Symptoms Associated with Classical Presentations of Transient Ischaemic Attack: Qualitative Analysis of Interviews with Patients

Susan Kirkpatrick, Louise Locock, Matthew F. Giles, Daniel S. Lasserson

Research output: Contribution to journalArticle

4 Citations (Scopus)
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Abstract

BACKGROUND: Improving the recognition of transient ischaemic attack (TIA) at initial healthcare contact is essential as urgent specialist assessment and treatment reduces stroke risk. Accurate TIA detection could be achieved with clinical prediction rules but none have been validated in primary care. An alternative approach using qualitative analysis of patients' experiences of TIA may identify novel features of the TIA phenotype that are not detected routinely, as such techniques have revealed novel early features of other important conditions such as meningococcaemia. We sought to determine whether the patient's experience of TIA would reveal additional deficits that can be tested prospectively in cohort studies to determine their additional diagnostic and prognostic utility at the first healthcare contact. METHODOLOGY AND FINDINGS: Qualitative semi-structured interviews with 25 patients who had experienced definite TIA as determined by a stroke specialist; framework analysis to map symptoms and key words or descriptive phrases used against each individual, with close attention to the detail of the language used. All interview transcripts were reviewed by a specialist clinician with experience in TIA/minor stroke. Patients described non-focal symptoms consistent with higher function deficits in spatial perception and awareness of deficit, as well as feelings of disconnection with their immediate surroundings. Of the classical features, weakness and speech disturbance were described in ways that did not meet the readily recognisable phenotype. CONCLUSION/SIGNIFICANCE: Analysis of patients' narrative accounts reveals a set of overlooked features of the experience of TIA which may provide additional diagnostic utility so that providers of first contact healthcare can recognise TIA more easily. Future research is required in a prospective cohort of patients presenting with transient neurological symptoms to determine how frequent these features are, what they add to diagnostic information and whether they can refine measures to predict stroke risk.
Original languageEnglish
Article numbere66351
Pages (from-to)1-5
Number of pages5
JournalPloS ONE
Volume8
Issue number6
DOIs
Publication statusPublished - 12 Jun 2013

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Transient Ischemic Attack
qualitative analysis
signs and symptoms (animals and humans)
interviews
Interviews
stroke
health services
Stroke
Delivery of Health Care
phenotype
cohort studies
Phenotype
Decision Support Techniques
prediction
Primary Health Care
Emotions
Cohort Studies
Language

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Non-Focal Neurological Symptoms Associated with Classical Presentations of Transient Ischaemic Attack : Qualitative Analysis of Interviews with Patients. / Kirkpatrick, Susan; Locock, Louise; Giles, Matthew F.; Lasserson, Daniel S.

In: PloS ONE, Vol. 8, No. 6, e66351, 12.06.2013, p. 1-5.

Research output: Contribution to journalArticle

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