“Mini” stroke can cause major disability, may warrant clot-busters
A transient ischemic attack TIA or a “mini stroke,” can lead to serious disability, but is frequently deemed by doctors too mild to treat, according to a study in the American Heart Association journal Stroke.
“Our study shows that TIA and minor stroke patients are at significant risk of disability and need early assessment and treatment,” said Shelagh Coutts, M.D., lead author of the study at Foothills Hospital in Calgary, Alberta, Canada. “We should be imaging patients earlier and be more aggressive in treating patients with thrombolysis if we can see a blockage no matter how minor the symptoms are.”
Thrombolysis is a treatment used to dissolve dangerous clots and restore healthy blood flow to the brain. TIA and minor stroke patients don’t typically receive this treatment because the condition is frequently not deemed serious enough to warrant it, researchers said.
Among the 499 patients studied, 15 percent had at least minor disability 90 days after their original “mini stroke.” Minor disability was defined as being unable to carry out previous activities, but capable of and handling personal affairs without assistance.
Computed tomography (CT) scans showed some “mini stroke” patients had narrowed blood vessels in the brain, and others reported ongoing or worsening symptoms. Those patients were more than twice as likely to have disability at 90 days. Coutts suggests that thrombolysis treatment should be considered in these patients.
Patients with type 2 diabetes had a similarly high risk of disability. Also, women were nearly twice as likely as men to be disabled 90 days after TIA.
“For every second after a mini stroke, the patient’s brain may be losing oxygen - possibly leading to a major event,” Coutts said. “If a scan finds that you have a narrowing of a blood vessel in or outside of the brain, you are at a high risk of being disabled.”
The warning signs of a TIA are exactly the same as for a stroke:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause
Why do some clots dissolve while others don’t? According to Dr. Emil Matarese, director of a primary stroke center at St. Mary’s Medical Center in Langhorne, Pa., the body has naturally occurring clot-busting agents. “Eventually all clots will dissolve, but whether there is damage depends on how long the clot is in place,” Dr. Matarese said. However, because there is no way to predict when a clot will dissolve on its own, time is of the essence. “Whenever you have stroke symptoms, dial 9-1-1 immediately and get to the emergency room so you can be evaluated. Don’t wait to see if the symptoms go away.”
Recurrent strokes posed the greatest threat to patients. Of those who had recurrent strokes, 53 percent were disabled, compared to 12 percent of patients without a recurrent stroke.
In 2009, the American Heart Association/American Stroke Association recommended immediate action and thorough testing for TIA - much like the exams performed after a full-blown stroke. These exams can show blockage in a brain blood vessel, which can increase patients’ risk of a subsequent, more serious event.
When an area of the brain loses its blood supply it stops working and the part of the body it controls also stops working. This is what happens with a stroke or CVA (cerebrovascular accident).
When the brain loses blood supply, it tries to restore blood flow. If blood supply is restored, function may return to the affected brain cells, permitting return of function to the affected body part. This is what happens with a TIA (transient ischemic attack). Some may consider this a mini-stroke, however, in reality, it is a stroke that has resolved or has improved functionality in the affected body part.
By definition, a TIA resolves within 24 hours, but most TIA symptoms resolve within a few minutes.
TIAs are often warning signs of a future stroke. The risk of a stroke increases dramatically in the days after a transient ischemic attack, and the TIA may offer an opportunity to find a cause or minimize the risk to prevent the permanent neurologic damage that results because of a stroke.
“The symptoms of a TIA - abrupt onset of inability to move one side of your body, numbness on one side, dizziness and trouble walking - may pass quickly,” Coutts said. “But, if you experience them, you should immediately go to the hospital, where proper scans can be done. Based on these results we have started a trial in Canada giving clot busting drugs to patients with mild symptoms, but blocked blood vessels in the brain.
“If ignored, these symptoms can lead to death. This is not a benign disease.”
Co-authors are: Jayesh Modi, M.D.; Andrew M. Demchuk, M.D.; Mayank Goyal, M.D.; Michael D. Hill, M.D.; Heidi Aram, R.N. and Shiel. K Patel, B.Sc. Author disclosures are on the manuscript.
The Canadian Institute of Health Research and a Pfizer Cardiovascular research award funded the study.
###
Stroke is treatable. The American Stroke Association is here to help you to recognize the warning signs of stroke, so you can respond fast in a stroke emergency. When you recognize a stroke and act fast by calling 9-1-1, you have a greater chance of improving the outcome, preserving independence and having a full recovery. To help recognize a stroke, remember F.A.S.T. and the symptoms that come on suddenly:
F – Face weakness
A – Arm weakness
S –Speech problems
T - Time to call 9-1-1
For a complete list of warning signs visit strokeassociation.org or call 1-888-4STROKE.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.
###
For Media Inquiries: (214) 706-1173
Maggie Francis: (214) 706-1382; .(JavaScript must be enabled to view this email address)
Karen Astle: (214) 706-1392; .(JavaScript must be enabled to view this email address)
Julie Del Barto (broadcast): (214) 706-1330; .(JavaScript must be enabled to view this email address)
For Public Inquiries: (800) AHA-USA1 (242-8721)