Mini Strokes: Major Health Threats

90% of people miss out on critical early treatment period, study finds

By Serena Gordon
HealthDay.com

Doctors call them transient ischemic attacks, but they're more commonly known as "mini-strokes."

But make no mistake -- they can be deadly.

What's worse, many people who suffer such an attack rarely seek medical help. Just one in 10 people who experienced symptoms of a transient ischemic attack (TIA) sought the proper emergency care, a recent study published in the journal Stroke found.

Urgent care is critical, because some people who suffer TIAs will have a major stroke as soon as a day or two after the mini-stroke.

"People need urgent medical attention not for the symptoms that have passed but for what might be coming. Many people don't have a TIA before they have a stroke, so, in a sense, it's fortunate to have one. Now you have a chance to intervene," said Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University Medical Center.

A transient ischemic attack occurs when blood flow to a part of the brain is temporarily blocked.

When this occurs, symptoms come on suddenly and last anywhere from a few minutes to many hours. Symptoms may include:
Sudden loss of speech or the ability to understand others. Rapid onset of weakness or numbness of the face, arm or leg, especially if it occurs on only one side of the body. Sudden loss of, or change in, vision that may occur in one or both eyes. Sudden difficulty walking or maintaining balance. One thing you may not feel with a stroke is pain.

"Pain is not the right thing to look for in stroke," said Dr. Christian Schumacher, a neurologist at the Stern Stroke Center at Montefiore Medical Center in New York City. "People expect that like a heart attack, which is often painful, that stroke will cause pain. But stroke symptoms are, in most cases, without pain."

One exception, Siller added, is what's known as a hemorrhagic stroke. In this instance, you would likely experience a sudden, severe, unexplained headache. If you have such a headache or any of the above symptoms, Siller said, you should get to the hospital immediately.

Unfortunately, not many people realize the need for urgent care. In the Stroke study, British researchers surveyed 241 people who had experienced a transient ischemic attack. Just 44.4 percent sought medical care within a few hours of experiencing TIA symptoms, and only 10 percent sought any emergency medical care for their symptoms.

Another 44 percent waited longer than a day after their symptoms to seek care. People who had symptoms that lasted more than one hour -- and those with motor symptoms, such as difficulty walking -- were more likely to seek care. If the TIA symptoms occurred on a weekend, people were more likely to delay seeking treatment.

People "want to wait until they feel better, and most TIAs get better within an hour. If it gets better, people just think, 'Oh, that was weird,' and then they may call their doctor later," Schumacher said.

Or, they may just forget the symptoms altogether, Siller said. "When symptoms are gone, and they feel better, people forget. But, it's a misconception that if it went away, it doesn't mean anything," he said.

"Although TIA is called a mini-stroke; it's like having a real stroke. It's a warning sign for a major disabling stroke," Schumacher said.

Getting to the hospital as soon as possible after TIA or stroke symptoms begin is critical. The reason: Clot-busting drugs that can spare you many of stroke's worst effects -- including paralysis -- have to be administered within several hours after the onset of symptoms to be effective, Siller explained.

"If you wait, we can't do as much to help you," he said.

Siller also recommends discussing your risk factors with your physician. The most common risk factor for stroke is a past history of a stroke or a TIA. People with high blood pressure, high cholesterol, diabetes and those with heart disease also have an increased risk of stroke, making it even more important for them to act quickly if they have any TIA symptoms.

--The American Heart Association has more on transient ischemic attacks.

SOURCES: Keith Siller, M.D., medical director, Comprehensive Stroke Care Center, New York University Medical Center, and assistant professor, New York University School of Medicine, New York City; Christian Schumacher, M.D., neurologist, Stern Stroke Center, Montefiore Medical Center, New York City

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