- The Washington Times - Sunday, March 11, 2001

Doctors have long suspected that transient ischemic attacks known as TIAs or ministrokes put people at a higher risk for having a full-blown stroke. Recent research, however, suggests the danger is even more pronounced than previously thought.

Researchers at the University of California at San Francisco followed 1,707 patients who had had a TIA. Of those patients, 180 had a stroke within three months of a TIA. Half of those strokes occurred within two days of the TIA, news that surprised the researchers.

"The data about what happens after a TIA hasn't been that clear," says Dr. S. Claiborne Johnston, a neurologist and the lead author of the study. "There has been so much variability in the way TIAs have been treated. Some patients are admitted. Some are sent home. Is this finding significant enough to justify doing aggressive treatment following a TIA? I think it is."

In Dr. Johnston's study, 14 percent of the patients (243 people) were hospitalized, and 8 percent (143 patients) were sent home with no treatment. Of the patients who had subsequent strokes, 38 died and 115 suffered stroke-related disabilities.

TIAs affect about 300,000 Americans annually, according to the National Stroke Foundation. High risk factors include age over 60, diabetes, high blood pressure, smoking, excess weight and family history of TIA or stroke.

TIAs are similar to strokes in that blood supply to the brain is interrupted. However, in a major stroke, the event blocks the blood vessel long enough to kill brain cells or to cause a blood vessel in the brain to rupture, Dr. Johnston says.

TIAs usually resolve themselves within a few hours and without major damage. It is still crucial, however, to see a doctor as soon as possible if one suspects he or she has had a TIA, says Dr. John W. Cochran, a neurologist at Inova Fairfax Hospital and director of Operation Stroke, a local campaign to increase public awareness of stroke.

Signs of a TIA include transient numbness in an arm or leg, blurred vision, trouble speaking or understanding, dizziness and loss of balance, Dr. Cochran says.

"These signs should not be ignored," he says. "I think there is a tendency to think 'Oh, that was nothing,' and then six weeks later, that person will have a big episode."

In the event of a TIA, evaluation by a doctor should include a CT scan and an electrocardiogram (EKG), Dr. Johnston says. A medical work-up is important so steps can be taken to prevent a future stroke, he says.

Treatment varies depending on a patient's age, lifestyle factors and other variables, such as blocked arteries, Dr. Johnston says. One of the most effective treatments is to put the patient on a daily aspirin regimen. Aspirin acts as a blood thinner to prevent clotting. Other options, depending on the patient's situation, include prescription blood thinners, anti-coagulants and surgery to remove fatty deposits from the neck's carotid artery.

Thrombolytic agents (also known as clot busters or t-PA) are used effectively within a few hours of a stroke to stem the episode's damage. These drugs are not effective in the case of a TIA, however, because the episode likely be over before permanent damage has occurred, Dr. Johnston says.

"The treatment for preventing a stroke is actually better than the treatment for a stroke," Dr. Cochran says.

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