"Urgent appointment for TIA/Stroke at MRI"

We saw your post about your referral to a TIA clinic and it sounds as if you are unhappy with how this has been conducted. It is unclear whether your GP has in fact referred you to a different hospital for a closer appointment, but I hope that this is the case. I hope that I can provide some information about TIAs and diagnosis to help you with deciding what step to take next, as well as some information about the Stroke Association and the other ways in which we might be able to help you.

A transient ischaemic attack (TIA) happens when the blood supply to your brain is interrupted for a brief time. It is sometimes called a ‘mini-stroke’. A TIA causes part of your brain to go without oxygen for a few minutes and is a sign that something is wrong and you may be at risk of a more serious stroke. The symptoms of a TIA are the same as those of a stroke but do not last for longer than 24 hours.

A TIA is a medical emergency and it is important that you telephone 999 if you experience any of the symptoms of stroke. A doctor should then assess your risk of subsequent stroke using a scoring system which takes into account your age, blood pressure, clinical symptoms, and the duration of the symptoms (this is called the ABCD2 test). People at low risk should be given aspirin and referred to a specialist within a week; people at high risk should be referred within 24 hours. This specialist can confirm the diagnosis of TIA, refer for a brain scan where appropriate, and provide information about reducing your risk of stroke. It sounds like your GP has done the ABCD2 test and made a referral, but that the clinic could not book this appointment for some time.

The ‘investigations’ that have been mentioned to you may mean a brain scan. A brain scan in most cases will confirm a stroke diagnosis as it shows the area of cells damaged by the lack of blood supply, but it may not confirm a TIA diagnosis. This is because a TIA does not always cause the same extent of damage to cells in the brain. The consultant may choose not to do a brain scan if it is thought that this scan would not show any damage (and therefore would not confirm a diagnosis of TIA) and if a TIA diagnosis has been made using other methods and tests. This could explain why the referral appointment specified that investigations would be done at a later date if appropriate, rather than on the day.

This information about TIA has come from the Royal College of Physicians guideline to ‘Diagnosis and initial management of transient ischaemic attack’. These guidelines are not legally binding but most hospitals and GPs try to follow them. I have attached a link to this document below:

http://www.rcplondon.ac.uk/sites/default/files/transient-ischemic-attack-concise-guideline.pdf

I have attached a link to a factsheet on TIA for further information. Please note you can download our full range of leaflets and factsheets free of charge from our website http://www.stroke.org.uk

Transient Ischaemic Attack

http://www.stroke.org.uk/sites/default/files/Transient%20ischaemic%20attack%20(TIA).pdf

It sounds like you are not happy with the speed of the referral to a TIA clinic. It might be helpful to speak to the Patient Advice Liaison Service (PALS). They provide confidential support and help to resolve problems and concerns with the GP and hospital. In addition, they can provide information on complaints procedures. They will also be able to direct you to an advocacy service in the area. It is really important to raise your concerns to the NHS so that they can improve their services and resolve problems. To find out the number for your local Patient Advice and Liaison services you can contact NHS Direct on 0845 4647.

PALS are part of the NHS, but if you wished to complain with the assistance of an independent body you could contact ICAS, an advocacy service for people who wish to make a complaint about health and social care.

http://icas.org.uk/default.aspx

At the Stroke Association we have support workers across the UK, providing information, advice and support to people affected by stroke. Our services are funded by PCTs or social services and we receive referrals from hospitals, social services, friends and family and self-referrals; this helps us to support people affected by stroke from the moment of diagnosis. Sadly, not all areas provide funding for these services so we also campaign to raise awareness about stroke, demonstrating the need for our services, and encourage people to understand more about the long term effects of stroke.

Our current campaigns include the Life after Stroke campaign, which challenges some of the barriers to recovery, such as social care, benefits, NHS care and rehabilitation. We are also involved in campaigns against cuts to benefits and services, and we produce Stroke Care Reports which highlight positive and negative aspects of local stroke services. You may wish to join our campaign, - this can be done on our website:

http://www.stroke.org.uk/campaigns/the_campaigners_network/index.html

You may also wish to contact Patients Association, which is an organisation dedicated to campaigning about issues with healthcare services. They have a helpline where you can provide your views about a service; they undertake regular surveys of patient opinions about services; and they produce a newsletter called Patient Voice which contains recent news and opinion about the NHS. I have included their contact details below:

Patients Association

PO Box 935

Harrow

Middlesex

HA1 3YJ

Helpline: 0845 608 4455

I hope this is helpful. Please do not hesitate to contact us if you require any further information or wish to find out more about services in your area. The Stroke Helpline is open Monday to Friday from 9am to 5pm on 0303 30 33 100.

Yours sincerely

Stroke Information Service

info@stroke.org.uk