Can a Doctor Miss a Transient Ischemic Attack?

By Lorra Garrick | Last updated 04/23

Have you ever wondered if a doctor can misdiagnose a transient ischemic attack as something benign?

Have you had any symptoms lately that you believed were a TIA but your doctor assured you otherwise, even though there was no hardcore test to verify this?

The medical establishment often refers to TIAs as mini-strokes. The only difference between a transient ischemic attack and a stroke is duration!

A TIA or stroke is when a blood clot lodges in a brain blood vessel.

Sometimes the clot is plaque material that made its way to the brain from a clogged carotid artery or coronary artery.

With a TIA, the clot dissolves quickly, leaving no permanent damage. In a stroke, the clot stays there and damage is usually permanent.

According to the American Stroke Association, it’s impossible to tell if a clot will dissolve on its own.

When to Call 9-1-1

The answer? Immediately. Do not wait to see if the symptoms will “go away,” as so many people do, only to regret this decision.

The American Stroke Association warns that there should be absolutely no difference in your response to a TIA and a stroke — whether age 35 or 70.

Elderly Man Blows off Suspicious Symptom

One day my father had sudden-onset double vision accompanied by a headache.

Upon entering the room, I saw him sitting in his chair, eyes closed, fingers to eyes, head lowered; he didn’t look good. I immediately suspected a TIA.

My father refused to go to the ER, but my badgering finally convinced him to e-mail his Kaiser Permanente general physician.

The doctor wanted him in next day. This “next day” turned out to be five days later.

My father told me that the doctor thought it might be a TIA, and that the doctor would consult with a neurologist.

A day went by and there was no e-mail from the Kaiser doctor. Next day, no e-mail. I found this unsettling because a suspected TIA is an extremely urgent situation.

My father sent a follow-up e-mail, and the doctor apologized for the delay and said that he had put in an order for a brain MRI and a blood test for an unnamed neurological disorder. And that was all.

I didn’t understand why, because according to American Family Physician, there are quite a few diagnostic tools for determining that a TIA occurred, including imaging of the carotid and aortic arteries.

The earliest that the MRI could get scheduled was 14 days out from the double vision event.

Nineteen days later the Kaiser doctor e-mailed my father that the MRI results were normal; no sign of stroke, tumor or other abnormality.

The blood test was also normal. And that was that; no other information from the Kaiser doctor!

It is NOT normal to experience sudden double vision, especially with a headache, even if transiently.

Alarmingly, the Kaiser doctor did not offer any explanation for the sudden-onset symptom.

His last e-mail was dead-end information with no suggestion of how to prevent this from recurring!

So it’s a fair question: CAN a doctor miss a transient ischemic attack?

“Yes,” says Atif Zafar, MD, medical director of St. Michaels Hospital in Toronto, Ontario, and former director of the stroke program at University of New Mexico Hospital.

“TIA is a transient event,” continues Dr. Zafar. “Often, patients share what they remember.

“The information passed through can be confusing — whether a family member witnessed the event — and are they around during the emergent evaluation.

“If the information is not accurate, or, if the physician is not confident in their neurological exam, this can be missed.”

A TIA may also be missed if the patient doesn’t present with the classic risk factors such as being over 50, having hypertension or having an unhealthy body weight.