"Mini" stroke can cause major disability, may warrant clot-busters

A transient ischemic attack TIA or a "mini stroke," can lead to serious disability, but is frequently deemed by doctors too mild to treat, according to a study in the American Heart Association journal Stroke.

"Our study shows that TIA and minor stroke patients are at significant risk of disability and need early assessment and treatment," said Shelagh Coutts, M.D., lead author of the study at Foothills Hospital in Calgary, Alberta, Canada. "We should be imaging patients earlier and be more aggressive in treating patients with thrombolysis if we can see a blockage no matter how minor the symptoms are."

Thrombolysis is a treatment used to dissolve dangerous clots and restore healthy blood flow to the brain. TIA and minor stroke patients don't typically receive this treatment because the condition is frequently not deemed serious enough to warrant it, researchers said.

Among the 499 patients studied, 15 percent had at least minor disability 90 days after their original "mini stroke." Minor disability was defined as being unable to carry out previous activities, but capable of and handling personal affairs without assistance.

Computed tomography (CT) scans showed some "mini stroke" patients had narrowed blood vessels in the brain, and others reported ongoing or worsening symptoms. Those patients were more than twice as likely to have disability at 90 days. Coutts suggests that thrombolysis treatment should be considered in these patients.

Patients with type 2 diabetes had a similarly high risk of disability. Also, women were nearly twice as likely as men to be disabled 90 days after TIA.

"For every second after a mini stroke, the patient's brain may be losing oxygen - possibly leading to a major event," Coutts said. "If a scan finds that you have a narrowing of a blood vessel in or outside of the brain, you are at a high risk of being disabled."

The warning signs of a TIA are exactly the same as for a stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause

Why do some clots dissolve while others don’t? According to Dr. Emil Matarese, director of a primary stroke center at St. Mary’s Medical Center in Langhorne, Pa., the body has naturally occurring clot-busting agents. “Eventually all clots will dissolve, but whether there is damage depends on how long the clot is in place,” Dr. Matarese said. However, because there is no way to predict when a clot will dissolve on its own, time is of the essence. “Whenever you have stroke symptoms, dial 9-1-1 immediately and get to the emergency room so you can be evaluated. Don’t wait to see if the symptoms go away.”