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Small Stroke May Mean a Bigger One Is Close Behind

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In fact, one-quarter of the TIA patients in his study suffered some type of serious medical problem -- whether stroke, death, heart failure, heart attack, or another TIA -- in the first three months following the TIA, Johnston says.

The researchers also were able to pinpoint specific risk factors for stroke after a TIA: age over 65, diabetes, a TIA spell lasting longer than 10 minutes, and temporary weakness or speech impairment during the TIA, Johnston tells WebMD. "Each of these symptoms doubled their risk of stroke," he says.

"It's what we've been saying all along -- that if you have symptoms of stroke, get to the hospital," Johnston says. "Now we're saying if your symptoms go away, you still need to get to the hospital."

His study also points to the need for more effective drugs to treat TIA, Johnston tells WebMD. "Ninety-two percent of patients in this study got medications that have been shown to reduce stroke risk, but the medications didn't work. The drugs obviously are not strong enough."

In addition, most patients in the study were given aspirin -- "which is known to reduce stroke risk after TIA," Johnston says. "But it worked in only 20% of cases." He plans future studies of more aggressive treatments.

Calling the study "a major contribution," Jeffrey Saver, MD, neurology director of University of California-Los Angeles Stroke Center, tells WebMD, "This revises our understanding of how frequently TIA leads to stroke. It also suggests that if you have had a TIA, you got lucky, you dodged a bullet this time. But there's no guarantee you will get lucky the next time. If you have a TIA, you need to get to the hospital ER or contact your doctor and be seen -- preferably that same day.

"The study also indicates that people who experience TIA symptoms -- especially those considered to be at high risk -- should be admitted to the hospital so that treatment can get under way to avoid stroke, while those at lower risk may be adequately managed as outpatients," Saver says.

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