Seeking help after a transient ischaemic attack (TIA): routes to care

A TIA is a sign that part of the brain is not getting enough blood and that there is a risk of a more serious stroke in the future. There is no way of knowing whether a stroke or a TIA is occurring during the first few hours, so a TIA should be treated as an emergency and medical help should be sought immediately. If in any doubt the best advice is to call 999.
People we talked to had sought help at different stages and through a range of different routes, including a routine or urgent GP appointment, calling an ambulance, calling NHS Direct or going straight to the Accident and Emergency Department. Some said it was difficult to know when or whether to seek medical help. It could sometimes be difficult to convince the GP’s receptionist that a ‘same day’ or ’emergency’ appointment was needed. Often this was because people did not recognise their symptoms as being serious (see Symptoms‘ and ‘Delay in seeking help‘) and so help was not sought immediately, particularly where the episode only lasted a short time.

Angus wife was going to call for an ambulance but the symptoms soon disappeared so he decided to…

Age at interview 61

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Age at diagnosis 60

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Phillips symptoms only lasted a short while and seemed trivial to him, but when he told his wife…

Age at interview 72

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Age at diagnosis 71

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Phillip (above) rang the surgery the next morning and was quite surprised that it was treated as very urgent and he was referred to hospital that same day. Even where the symptoms did not seem to go away quite so quickly, it could still be easy to misinterpret what was happening.
Yvonne was on her way to work when she began to experience a range of symptoms and felt very unwell. She thought it was probably a reaction to some medication she’d been prescribed, or the beginning of a migraine, so she carried on with her day and did not seek medical advice or help immediately, despite the fact that colleagues told her she looked really unwell. Yvonne left it till she had a routine appointment to see the GP the following Monday. Like Phillip, she was surprised at how urgently her GP reacted when she was referred immediately to a TIA clinic but even then was still not aware of the urgency because she did not know what TIA stood for (see ‘Understanding TIA/minor stroke‘ and ‘Delay in seeking help).

Yvonne almost collapsed when she arrived at work, but carried on working for the rest of the day…

Age at interview 54

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Age at diagnosis 54

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In some cases people said they had a general awareness of what might be happening and so were more inclined to make the call to the GP more quickly. Martyn rang the GP himself as he had an idea that his symptoms might indicate a TIA (see ‘Medication, treatment and surgery‘).

Martyn experienced a short episode of numbness and tingling in his arm and shoulder whilst at…

Age at interview 64

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Age at diagnosis 57

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In many cases it was a partner, friend or relative who called for help. Typically this was where the person experiencing symptoms was unable to communicate, or had collapsed. Rosemary was prompted to call an ambulance when her husband Brian (Interview 08) woke from a nap complaining that his vision was blurred and he was feeling dizzy and somewhat disorientated. Rosemary called for help sooner rather than later because since her husband’s heart attack she had been told if in doubt to call the paramedics immediately.

Rosemary feels its very important to seek help for someone when they are experiencing…

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When Geoff woke up one night feeling that he was going to be sick, it became evident to Enid his wife that he was also unable to move. Realising that he needed help straight away Enid called the GP, who recognised the urgency and arranged for an ambulance to take Geoff to hospital where he was assessed and immediately admitted for treatment.

Enid rang the doctor as soon as she realised that Geoff was unwell…

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Age at diagnosis 65

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When Adrian had a TIA at home one evening, his partner recognised what she thought were the symptoms of stroke from having seen the ‘FAST’ campaign advert on TV (FAST stands for ‘Face, Arms, Speech – Time to call 999′). She called the ambulance straight away and paramedics arrived at home where he was assessed before being taken to hospital.

Adrians partner recognised the symptoms of stroke from seeing the FAST TV advert and immediately…

Age at interview 53

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Age at diagnosis 53

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While several people said the FAST campaign had helped them be alert to possible symptoms, those with visual disturbance or a feeling of disorientation did not necessarily make the connection between their symptoms and FAST.
In most cases where an ambulance was called, the person was examined at home by the paramedics, and then usually taken in to A&E to be assessed (see Adrian above). One woman collapsed in the supermarket and a supervisor called for an ambulance. Some people we talked to were able to go home straight away, but others stayed in hospital.
Some people said they did not want to stay in hospital and were reluctant to be admitted. Adrian (above) said he had been glad that he was able to return home as he hated hospitals. Clare had been taken ill at work and a colleague had called for an ambulance. She was taken to hospital and was admitted overnight.

Clare wanted to go home that evening but the doctor insisted she stayed in hospital overnight.

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Keith stayed in hospital overnight but was keen to get home as soon as possible. On discharge he…

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Not everyone was satisfied with the way they were dealt with when they were assessed in A&E. Gilly was taken to A&E by her colleague after collapsing at work, and although the emergency doctor she saw there thought it possible that she had had a TIA she was discharged and referred to a generalised clinic specialising in ‘unexplained events’ rather than one that dealt specifically with strokes.

In Gillian’s case it was felt initially that she might have a urine infection, and the next day when she saw her GP and the tests came back clear she was told that no further action was needed. However Gillian felt that it was important to know what had happened to her so that she could get a diagnosis and treatment.

Gillian was seen by her doctor the day after the episode and she was given a non urgent…

Age at interview 92

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Age at diagnosis 90

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