Mini-Stroke Can Mean Major One Within Hours

If full-blown stroke occurs, it often comes within a day, study shows

By Ed Edelson
HealthDay Reporter

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MONDAY, June 1 (HealthDay News) -- About half the people who have a major stroke soon after a less serious brain event, such as a transient ischemic attack or "mini-stroke," do so within 24 hours of the minor event, a new study finds.

The message here for people who have a TIA is to "seek medical attention immediately, particularly if you have either weakness or speech disturbance that lasts more than 10 minutes," said the study's senior author, Dr. Peter M. Rothwell, a professor of clinical neurology at the University of Oxford in England.

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"Don't wait until the next day -- it may be too late," he said.

Reporting in the June 2 issue of Neurology, Rothwell and his colleagues looked at the medical records of 1,247 people who had a TIA, which is a momentary blockage of blood flow in a brain artery.

Of those, 35 went on to have recurrent strokes within the next 24 hours. In that group, 1.2 percent of the second strokes occurred within six hours, 2.1 percent within 12 hours and 5.1 percent within 24 hours, the team found.

"That about half of all the recurrent strokes in the seven days after a TIA occur in the first 24 hours highlights the need for emergency assessment," the researchers wrote.

That assessment should look at the well-established "ABCD2" stroke risk factors, Rothwell said. These include:

• A: age over 60
• B: blood pressure reading that is high
• C: clinical symptoms of physical weakness
• D: duration of the TIA

"Patients should be investigated and treated as an emergency, certainly those with a high ABCD2 score," Rothwell said.

While TIAs and minor strokes are well known to be warning signs of major trouble ahead, "no study has shown how high the risk is in the first few hours -- i.e., that TIA and minor stroke is a true neurological emergency," he said.

Immediate action can lessen the risk, Rothwell said. "We published a paper in Lancet in November 2007 looking at the benefits of emergency treatment versus standard treatment," he said. "We showed that the risk of major stroke can be reduced by up to 80 percent simply by initiating standard treatment as an emergency measure -- aspirin plus or minus clopidogrel [Plavix], statin therapy, blood pressure reduction."

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