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Mini-Strokes Can Be an Ominous Prelude
to Catastrophic Strokes

Each year, more than 200,000 Americans experience mini-strokes known as transient ischemic attacks (TIAs).

Patients suffer strokelike symptoms such as paralysis on one side or difficulty speaking. While symptoms typically disappear in less than a few minutes and there's no brain damage, TIAs often are followed by severe strokes.

TIAs are an “ominous prelude to an impending cerebrovascular catastrophe, but also the opportunity to prevent a disabling event,” Loyola Medicine neurologists Camilo R. Gomez, MD; Michael J. Schneck, MD; and José Biller, MD, report in the journal F1000Research. However, the Illinois neurologists add that rapid evaluation and treatment can reduce the risk of stroke by about 80% during the dangerous first week following a TIA.

Most strokes are ischemic, meaning they are caused by blood clots that block blood flow to a part of the brain. TIAs also are caused by blood clots, but the clots quickly dissolve or are dislodged. However, there's a 5% to 10% risk of suffering a stroke during the 30 days following a TIA, and 15% to 20% of ischemic stroke patients report having experienced an earlier TIA.

A TIA requires urgent management, but there is controversy about how to accomplish this. Should patients be temporarily hospitalized, which may be safer, or should they be evaluated on an outpatient basis, which may be more convenient and cost-effective? The existing literature is inconclusive. “Both approaches have advantages and disadvantages,” the authors wrote.

Traditionally, TIA patients have been admitted for a 23-hour observation period after they come to the emergency department. A recent alternative is to refer patients to a “TIA clinic,” where they are quickly seen by a stroke neurologist, undergo diagnostic tests, and have access to a multidisciplinary network of cardiologists, neurosurgeons, vascular surgeons, and other relevant specialists.

Therapeutic strategies include antiplatelet therapy (aspirin and other drugs that stop blood cells called platelets from sticking together and forming a clot), Coumadin and other blood thinners, surgery or stent placement to open clogged arteries, therapy to control blood pressure and cholesterol, diabetes screening, and patient education.

“Patients must be counseled about smoking cessation, proper diet (preferably Mediterranean), regular exercise, maintenance of appropriate [body mass index], and limiting alcohol consumption,” the authors wrote.

“The diagnosis of a TIA represents the recognition of a medical emergency and an opportunity to reduce the risk of stroke by decisively evaluating the patient and applying any combination of the currently available therapeutic strategies,” according to the authors. “The future is likely to show additional methods of early diagnosis, better algorithms for stroke risk stratification, and enhanced systems of care for these patients.”

— Source: Loyola University Health System