Imagine being rushed to the ER and diagnosed with a “ministroke.” You might be told that your symptoms are mild and short-lived and that you can probably expect to be just fine.
A happy ending? Not necessarily—because a new study has called into question the common assumption that “little” strokes generally have few or no lasting consequences.
In fact, the researchers found that there is a substantial risk for disability after such an event even for patients who do not go on to have another stroke…and they suggested that doctors might not be giving enough patients the special medication that can prevent such disability.
The info you need to protect yourself…
SMALL STROKE, BIG DEAL
First, a little bit of background. Ischemic stroke, the most common type, occurs when a blood clot blocks blood flow to the brain. Symptoms include sudden weakness or numbness on one side of the body, slurred speech, dizziness and vision problems. With a major stroke, if the patient survives, such symptoms can be severe and long-lasting, resulting in permanent disability.
In contrast, with a ministroke or transient ischemic attack (TIA), symptoms typically last only a few minutes and might leave no obvious permanent neurological damage. With a minor stroke, which is worse than a TIA but not as bad as a major stroke, symptoms are mild but persistent.
When a patient suffers a major stroke, medication called tissue plasminogen activator (tPA)—which must be administered within a few hours of symptom onset—can break up the clot, opening the blocked blood vessel and restoring blood flow to the brain, minimizing disability. However, in the case of a TIA or minor stroke, doctors often assume that patients will not suffer permanent problems and thus consider the condition too mild to warrant treatment with tPA or another anticlotting therapy. This is the assumption challenged by the new study.
SURPRISING STUDY FINDINGS
Canadian researchers investigated 499 ER patients who had had a TIA or minor stroke, following their progress for 90 days. What they discovered: Within three months, 15% of these patients developed some form of physical and/or cognitive disability.
Those are not very good odds!
I talked to the lead researcher, Shelagh Coutts, MD. She told me that, while the study patients’ disabilities weren’t necessarily profound, they were severe enough in some cases to interfere with the ability to drive, work, socialize and handle finances.
If you develop possible symptoms of stroke, no matter how mild or temporary, do not brush them off, Dr. Coutts cautioned. Instead, get to an ER right away. You need to be tested immediately to determine whether there has been any damage to your brain. Testing should include a CT scan…and possibly a CT angiography (CTA), a test in which a contrast dye is administered to show any blood vessel blockages or narrowing from the top of the heart to the top of the brain.
You might also want to ask your doctor whether tPA or some other clot-busting thrombolytic drug is appropriate for you. Ministroke and minor stroke patients most likely to develop disabilities—and thus most likely to benefit from such treatment—include those who…
- Have blocked or narrowed blood vessels in the brain, as shown on the CTA.
- Have ongoing symptoms (rather than symptoms that disappear after a few minutes).
- Have diabetes.
- Are women—because, for unknown reasons, females are more likely than males to develop poststroke disabilities.
Why not just give tPA to all stroke patients, no matter how minor their strokes? Because tPA is a powerful and potentially risky drug. It has a chance of causing bleeding in the brain, resulting in a hemorrhagic stroke. Dr. Coutts said, “Studies are now needed to see if the risk/benefit balance is in favor of treatment in these patients. In Canada, we are doing a study treating minor stroke patients with blockages within the brain to determine the safety of thrombolysis.”
It is also important to note that tPA is not safe for certain patients, such as those taking warfarin (Coumadin) or another anticoagulant…those who recently had a head injury, heart attack or surgery…pregnant women…patients with very high blood pressure…or those with any type of bleeding problem.