'Mini-Strokes' May Be More Damaging Than Thought

THURSDAY Sept. 13, 2012 -- Many people who have "mini-strokes" struggle with serious, lingering disabilities, even though the condition typically is considered too mild to treat, Canadian researchers report.

The findings suggest that it might be time to rethink that "hands-off" approach, they added.

Although powerful drugs such as tissue plasminogen activators (tPA) usually are given to patients who have suffered major strokes to restore blood flow to the brain, some people experiencing mild strokes (TIAs) might also benefit from such medications, the researchers said.

"About 80 percent of the patients we see are in that mild stroke category; only a small proportion have big strokes," said lead researcher Dr. Shelagh Coutts, assistant professor of neurology at the University of Calgary. "This is the largest proportion of patients we see."

Many of the patients with TIAs need to be seen more quickly in the emergency room, Coutts said. "These patients need to be seen early and decisions made about treatment made quickly," she said.

The report was published in the Sept. 13 issue of Stroke.

Coutts's team found that among almost 500 TIA patients, 15 percent had at least a minor disability three months after their mini-stroke. A minor disability is one that prevents a person from doing activities they once did, such as driving, but doesn't limit one's handling of their personal affairs, Coutts said.

CT scans found some patients had narrowed blood vessels in the brain, while others had ongoing or worsening symptoms. Patients with those problems were at more than twice the risk of having a disability 90 days after their TIA, the researchers found.

These patients are the ones most likely to benefit from a low dose of a clot-busting drug, such as tPA, Coutts noted.

In addition, patients with type 2 diabetes had a high risk of disability, and women were almost twice as likely to have a disability as men, the researchers noted.

After a mini-stroke, the patient's brain may be losing oxygen, raising the chances of a major stroke, Coutts said.

Patients at the greatest risk are those who suffer a series of TIAs. Fifty-three percent of these patients had a disability, compared with 12 percent of those who had only a single mini-stroke.

TIA symptoms include a sudden inability to move one side of the body, numbness on one side, dizziness and trouble walking and speaking. These symptoms may pass quickly, but should not be taken lightly because ignoring them could be fatal, Coutts said.

"This is another important paper adding to the evidence that mild stroke may not be so mild when we evaluate the impact on subsequent disability," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine. "We also know that patients with TIA are at high risk for subsequent stroke."

The study adds to the urgency of rapid diagnosis and treatment of all TIA and stroke patients, to reduce recurrence and improve outcomes, Sacco said.

"Patients and physicians need to take any stroke symptoms -- even the mild or rapidly vanishing ones -- very seriously," he said.

Another expert, Dr. Igor Rybinnik, a neurologist at the Cushing Neuroscience Institute at North Shore-LIJ Health System in Manhasset, N.Y., added that a TIA is a "wake-up call telling you bigger strokes may be coming."

Rybinnik said such an episode should make patients reduce their cardiovascular risk factors by lowering their blood pressure and cholesterol, quitting smoking and maintaining a healthy weight.

To help recognize symptoms of a stroke, the American Stroke Association recommends remembering the acronym "F.A.S.T.":

  • F: Face weakness
  • A: Arm weakness
  • S: Speech problems
  • T: Time to call 911

More information

For more on stroke, visit the American Stroke Association.

Posted: September 2012


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