Stroke Stroke Prevention

Preventing Mild Strokes from Becoming Serious

Researchers in England have developed a scoring system that may predict the risk of a serious stroke occurring soon after a minor one.

Overall, about 40 percent of patients who have a minor stroke, known as a transient ischemic attack (TIA), go on to develop a full-blown stroke or heart attack within 10 years. Until now, there has been little way of telling who is at a greater risk shortly after a mild attack, a crucial time for intervention.

In a recent study published in The Lancet, Dr. Peter Rothwell and colleagues at the University of Oxford found that the more immediate dangers appear related to a person's age, blood pressure, clinical features and duration of the transient attack. These "ABCD" symptoms, the researchers suggest, can help identify high-risk patients who are in need of urgent treatment.

Rothwell's team studied 209 patients who were examined by a doctor after having a suspected TIA and another 190 who remained hospitalized. Within a week of being assessed, 38 patients suffered a major stroke.

The researchers developed a scoring system based on well-established risk factors for a recurrent stroke, which includes being older than 60 years of age, having high blood pressure and suffering stroke symptoms for more than one hour.

When these factors were added together with other risks—such as weakness on one side of the body or slurred speech—the team found that the ABCD test could quickly determine who has a greater chance for an immediate stroke. In fact, 95 percent of patients who were examined by a doctor after a transient attack and had a higher score suffered a serious stroke within the week.

The test has two purposes, the researchers state: it helps define who should stay in the hospital for further care, as well as which patients can be appropriately managed at home.

In the United States, stroke experts say they are not taking any chances. "We keep anyone who has a TIA in the hospital for 48 hours," says Dr. Ralph Sacco, a neurologist at the Columbia University College of Physicians and Surgeons.

Sacco says that the British study helps define who may be at greater risk, but the dangers of a further stroke are clearly present for two days after a transient attack. "Half the risk of another stroke is within the first 48 hours," he says.

There are a variety of medications that can prevent future strokes, such as aspirin and newer antiplatelet drugs. The key, however, is to recognize the symptoms of a minor stroke and seek help fast.

Symptoms to look out for include weakness or numbness on one side of the body, or a small part of the body, such as in the fingers, upper arm or foot. Slurred speech for a short time is another sign, as well as a loss of vision in one eye or difficulty walking. Getting to a hospital or specialized stroke center within the first 24 hours of noticing TIA symptoms may help prevent a more serious attack, says Sacco. "Time is of the essence."