Ministroke: Quick Care Pays Off

Oct. 8, 2007 -- When a "ministroke" strikes, immediate medical care may help prevent a bigger stroke.

That's the take-home message from two new studies published in tomorrow's edition of The Lancet.

A quick review: Stroke can be caused by a blood clot (ischemic stroke) or bleeding in the brain (hemorrhagic stroke).

Transient ischemic attacks (TIAs) can precede ischemic strokes. In a TIA, stroke symptoms flare up and quickly fade. TIAs technically aren't strokes, but they're often called "ministrokes."

Stroke symptoms can include:

• Sudden weakness or numbness in the face, arm, or leg on one side of the body.
• Abrupt loss of vision, strength, coordination, sensation, speech or the ability to understand speech. These symptoms may become more marked over time.
• Sudden dimness of vision, especially in one eye.
• Sudden loss of balance, possibly accompanied by vomiting, nausea, fever, hiccups, or trouble with swallowing.
• Sudden and severe headache with no other cause followed rapidly by loss of consciousness -- indications of a stroke due to bleeding.
• Brief loss of consciousness. Unexplained dizziness or sudden falls.

Seek emergency medical care at the first sign of those symptoms. The stakes are too high not to take action, even if the symptoms disappear quickly.

British Stroke Study

The two new stroke studies show benefits from quick care for stroke or minor stroke.

One of the two new stroke studies comes from Oxford, England.

At the study's start, TIA or minor stroke patients needed a doctor's referral to go to a special stroke clinic. Later, the referral requirement was waived.

When patients didn't need a referral, they came to the clinic sooner.

As a result, those patients were 80% less likely to have a stroke within three months of their TIA or minor stroke, compared with those treated when the referrals were required.

French Stroke Study

The second study comes from Paris, where stroke experts set up a 24-hour TIA clinic and publicized the clinic with local doctors.

Some 700 patients with confirmed TIA or minor stroke came to the clinic within 24 hours of the start of their symptoms.

As a result, they were less likely to have a stroke in the next three months, according to Philippa Lavallee, MD, and colleagues.

Lavallee works for the Department of Neurology and Stroke Centre at the Denis Diderot University and Medical School in Paris.

New Standard

TIAs and minor strokes warrant urgent care, write editorialists in The Lancet.

"Rapid assessment and intervention is emerging as the new standard for TIA care," write the editorialists, who included Water Kernan, MD, of Yale University's medical school.