| Physicians have known for years that
patients who suffer transient ischemic attacks (TIAs), brief interruptions in the blood
flow to the brain, are at risk for heart disease or strokes sometime in the future. However, a new study finds the risk of
stroke may be almost immediate, often within days of a TIA. Therefore, the researchers say
that patients who suffer TIAs should seek medical attention as soon as possible so
immediate precautions may be taken to decrease the risk of stroke. Physicians describe a TIA as a "mini"
or "little" stroke in which the blood supply to the brain is temporarily
stopped. According to the American Heart Association, more than a third of patients who
have mini strokes will suffer strokes in the future. A TIA usually results in a sudden and
brief decrease in brain function. Symptoms of TIAs commonly include sudden speech
difficulties, vision changes, loss of balance, weakness, numbness in the limbs, or lack of
coordination. These symptoms are temporary; they may last only a few minutes or up to 24
hours.
To conduct their study, S. Claiborne
Johnston, MD, assistant professor of neurology at the University of California-San
Francisco, and his colleagues studied medical records from 1707 patients who suffered TIAs
to determine the short-term risk of stroke and other health problems after emergency room
diagnoses of TIA. The average age of the patients was 72 years old. Dr. Johnston and his
team found that approximately 25% of the patients (428 patients) went on to suffer strokes
or other adverse effects within 90 days of a TIA. Of the 180 patients who returned to the
emergency room with strokes, 91 of 180 of the patients suffered strokes within two days of
having a TIA.
"Our results indicate that the
short-term risk of stroke and other adverse effects among patients who present to an
emergency department with a TIA is substantial," conclude the researchers. Their
study, which is the first large-scale study on TIAs, is published in the December 13, 2000
issue of the Journal of the American Medical Association.
Because the symptoms of TIAs are
temporary, many people do not go to the hospital when those symptoms occur. However, Dr.
Johnston says patients should seek immediate treatment, even if symptoms are transient. Of
the patients in the study who suffered strokes or other adverse effects within 90 days of
a TIA, 44 patients were hospitalized for cardiovascular events (2.6%), 45 patients died
(2.6%), and 216 patients experienced recurrent TIAs (12.7%).
Dr. Johnston and his colleagues were
able to identify a few additional risk factors for stroke among the patients who suffered
TIAs. Those factors included:
- Age (over 60 years old)
- Having diabetes
- Having TIA symptoms that lasted longer
than 10 minutes
- Experiencing speech impairment or
weakness during a TIA
Treatment of TIAs usually focuses on
improving the arterial blood supply to the brain and preventing future strokes. A complete
physical evaluation is usually performed. Patients considered at high risk for stroke may
be admitted to the hospital after suffering a TIA while others may be treated as
outpatients. Aspirin is the most commonly used medication to reduce clotting. Other
medications may include dipyridamole, heparin, Coumadin, or others. Depending on the
patient’s medical history, medical conditions, and other factors, additional
treatments may also be given (such as treatments for blood disorders, high blood pressure,
high cholesterol, dietary changes, etc.). Some patients may also benefit from carotid artery surgery (carotid endarterectomy), which involves
removing fatty deposits and plaque from one of the two main arteries in the neck supplying
blood to the brain.
Dr. Johnston’s study suggests that
further studies are needed to investigate better methods of treating TIAs to reduce the
likelihood of future strokes. In the meantime, patients who experience symptoms of TIAs
should seek immediate medical attention.
Additional Resources and References
- The study, "Short-Term Prognosis
after Emergency Department Diagnosis of TIA," is published in the December 13, 2000
issue of the Journal of the American Medical Association (JAMA). An abstract of the
study is available on the JAMA website, http://jama.ama-assn.org/
- The December 12, 2000 WebMD report by
Jeanie Davis, "Small Stroke May Mean a Bigger One is Close Behind," is available
at http://my.webmd.com/condition_center_content/str/article/1728.66555
- The December 12, 2000 Associated
Press report, "'Mini-Stroke' Warrants Urgent Attention," is available within
30 days of publication at http://dailynews.yahoo.com/h/nm/20001212/hl/ministroke_1.html
- To learn more about stroke, please visit
http://www.imaginis.com/stroke/
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