Quick action after a minor stroke reduces the risk of a major stroke

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According to two studies by British and French researchers quick action following a minor stroke reduces the chance of a major stroke later on.
The British researchers at the University of Oxford say immediately treating small strokes cuts the risk of a disabling or deadly stroke in the next 30 days by about 80 percent.

For the study the researchers were interested in looking at ischaemic strokes which are caused by a blood clot, and not the more unusual haemorrhagic strokes, which are caused by bleeding in the brain.

Neurologist Peter Rothwell who led the UK study says these mini-strokes are essentially warning events and most follow-on strokes happen within 30 days of a smaller one, however most patients do not receive treatment for weeks.

A stroke occurs when the blood flow to the brain is blocked; it can kill brain tissue and is one of the world's leading cause of death and permanent disability.

TIAs are caused by a temporary interruption in blood flow to the brain and can be a warning sign of a major stroke.

Current treatments include blood thinning drugs and efforts to lower cholesterol.

The risk of a major stroke occurring in the first month after a minor stroke - a transient-ischaemic attack (TIA) is currently 10%.

The symptoms of TIAs are similar to a stroke and include slurred speech, dizziness, or numbness on one side of the body but unlike a stroke symptoms disappear completely over several hours.

For the study the researchers were interested in looking at ischaemic strokes which are caused by a blood clot, and not the more unusual haemorrhagic strokes, which are caused by bleeding in the brain.

The first part of the study looked at patients who had to wait for an average of three days for an assessment, and an average of 20 days to receive treatment - usually drugs - in a standard primary care setting.

Among this group of 310 patients, 10.3% had a major stroke within 90 days of first seeking medical attention.

However, in the second part of the study patients were assessed and given treatment at a specialist clinic within one day; in this group of 281, the risk of a stroke within 90 days was cut to 2.1%.

The reduction in risk was independent of age and sex, and early treatment did not increase the risk of bleeding or other complications.

The researchers found the risk of a major stroke within the first month following a minor one fell to about 2 percent from 10 percent for patients who received treatment almost immediately and they estimate that early treatment could help prevent 100,000 strokes each year in Britain alone.

Rothwell says the vast majority of patients in Britain do not receive treatment for the first few weeks, which is the same in the United States and most of Europe.

French researcher Pierre Amarenco and colleagues at Denis Diderot University in Paris established a hospital clinic with 24-hour access to treat patients with suspected TIAs.

They also found that early aggressive treatment brought similar results in cutting the chance of a major stroke.

Both studies are published in the Lancet Neurology.