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Minor Stroke a Major Warning

Full-fledged brain attack likely within a week, study finds

MONDAY, March 7, 2005 (HealthDay News) -- A "mini-stroke" is a warning that a major stroke is likely to happen in the next few days, and current treatment guidelines should be changed to reflect that danger, British researchers report.

Data from two major studies show that nearly a quarter of 2,416 people diagnosed with major ischemic stroke -- the kind that happens when a brain artery is blocked -- had also recently experienced a mini-stroke (better known to doctors as a transient ischemic attack or TIA), usually in the week preceding the major attack.

"Guidelines should be changed such that TIA and minor strokes are classified as medical emergencies that deserve urgent attention," said co-researcher Dr. Peter M. Rothwell, a professor of neurology at Oxford University.

The report, published in the March 8 issue of Neurology, accentuates "something we've known about and have been writing about for some time," added Dr. Larry Goldstein, a professor of medicine at Duke University Medical Center and vice chairman of the American Heart Association's (AHA) stroke council.

Guidelines issued by the AHA and its branch, the American Stroke Association, are now undergoing "a complete revision," and the changes likely will take into account these latest findings, he said.

"In my personal opinion, a TIA should be viewed as an emergency," Goldstein said. "The highest risk of a stroke is very soon after a TIA happens."

Rothwell and his co-researcher, Dr. Charles P. Warlow, gathered data from a study conducted in Britain and another study taking place in Europe. They found that 23 percent of the people who suffered ischemic strokes had experienced a TIA beforehand. In 17 percent of those cases, the TIA occurred on the same day as the major stroke, while in 9 percent of cases the mini-stroke occurred one day before the major event. In 43 percent of those cases, the mini-stroke happened sometime in the seven days before the stroke.

"We have known for some time that TIAs are often a precursor to a major stroke," Rothwell said. "What we haven't been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective treatment. This study indicates that the timing of a TIA is critical and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack."

Treatments that are known to be effective include powerful drugs to prevent blood clots and carotid endarterectomy, a procedure where surgeons remove deposits from the major artery supplying blood to the brain.

Newer treatments that are in advanced stages of testing include high-dose therapy with cholesterol-lowering statins and a drug therapy that combines aspirin with Plavix, a drug that prevents clots, the report said.

Patients and doctors should pay attention to the importance of acting quickly when a TIA occurs, Rothwell said.

"Patients should seek medical attention immediately and physicians should arrange specialist assessment within 24 hours," he said.

According to the American Stroke Association, both mini-strokes and major strokes can cause a variety of symptoms, including weakness and numbness of the face, arm or leg; confusion; trouble seeing or walking; dizziness; or severe headache.

About 600,000 strokes -- 150,000 of them fatal -- occur in the United States each year, the American Academy of Neurology estimates. About 80 percent of strokes are ischemic, while the others are hemorrhagic, occurring when a blood vessel bursts within the brain.

More information

To learn more about recognizing and responding to a possible mini-stroke, head to the American Heart Association

SOURCES: Peter M. Rothwell, M.D., professor, neurology, Oxford University, England; Larry Goldstein, M.D., professor, medicine, Duke University Medical Center, Durham, N.C., and vice chairman, stroke council, American Heart Association; March 8, 2005, Neurology
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