Table 2 Case scenario 1a
True | False | Unsure | Evidence | |
|---|---|---|---|---|
n | n | n | ||
1.She may have had a TIA | 32 | 0 | 0 | At the time of the study a TIA was defined as a sudden focal loss of neurologic function with complete recovery usually within 24 hours [16].The National Institutes of Health (NIH) committee on the Classification of Cerebrovascular Disease defined the time based definition of TIA. In 1965 the arbitrary 24-hour time limit definition was adopted, in a setting where there was limited imaging or treatments for stroke [17]. A tissue based definition has been adopted since, with TIA now being a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction [18]. |
2.She may have had a stroke | 7 | 21 | 3 | |
3.A normal CT brain excludes a stroke | 8 | 23 | 0 | An early CT scan (within the first few hours) may be normal in ischaemic stroke. However, with experienced observers in up to 50 % of cases abnormalities can be seen on CT scan within 5 hours [19]. |
4.The differential diagnosis would include radiculopathy, cervical myelopathy or an intracranial pathology (e.g. tumour) | 23 | 4 | 4 | The diagnosis of TIA is clinical and can be challenging. The inter-observer diagnosis of TIAs even amongst neurologists has been reported to be poor [10]. The possible list of differential diagnoses can be extensive, ranging from significant neurological disorders to somatisation disorder. |