Study: `Mini-strokes' are a bigger danger sign than previously thought

CHICAGO (AP) _ Mini-strokes that involve brief lapses in blood flow to the brain may be a bigger danger sign than previously thought. <br><br>Doctors have long known that mini-strokes, or transient ischemic

Wednesday, December 13th 2000, 12:00 am

By: News On 6

CHICAGO (AP) _ Mini-strokes that involve brief lapses in blood flow to the brain may be a bigger danger sign than previously thought.

Doctors have long known that mini-strokes, or transient ischemic attacks, can be an early warning of a full-blown stroke. But new research suggests the danger may be much more imminent than doctors believed.

In a study of 1,707 patients, 180 had strokes within three months of a TIA, a 10.5 percent rate that was in line with previous research. But half of the strokes happened within just two days of the initial attack.

``No one expected that. That was a surprise,'' said Dr. S. Claiborne Johnston, who led the study at the University of California at San Francisco. It was published in Wednesday's Journal of the American Medical Association.

TIA patients ``need to basically call 911 and come in right away,'' Johnson said. ``They need to be taken very seriously by the patient and by the hospitals.''

Dr. John Marler of the National Institutes of Health, which helped fund the study, agreed that such patients may need immediate hospitalization, which could allow prompt treatment as well as quick use of diagnostic measures such as brain scans and ultrasound.

About 300,000 Americans each year have TIAs. Symptoms include sudden numbness and blurred vision but disappear within about 15 minutes to 24 hours and do not cause permanent damage.

Doctors commonly send TIA patients home, thinking ``that the work-up could be done over a week or two as an outpatient basis,'' Marler said. ``What this study is saying is we might not have as much time to do that work-up. It may have to be done on an expedited basis in a hospital.''

TIAs are difficult to diagnose, partly because symptoms often clear up by the time a patient receives medical attention. Some patients do not even call the doctor. Johnson said even patients whose symptoms go away should seek immediate treatment.

Treatment for TIAs varies widely. It may include aspirin and other blood thinners or surgery to clear severely blocked carotid arteries.

Some hospitals may send patients home with little or no treatment; in the study, just 14 percent were hospitalized, and 8 percent received no treatment, which Johnston said is typical. Aspirin was the most common treatment, given to nearly 70 percent of the patients.

The researchers studied patients age 72 on average who were diagnosed with TIAs at 16 emergency rooms in the San Francisco area, Sacramento and Santa Rosa, Calif. The hospitals were part of the Kaiser-Permanente Northern California health maintenance organization network.

Dr. Allan Bernstein, chief of neurology at Kaiser's Santa Rosa Medical Center, said the figures do not show which treatments were best.

``Nobody's really quite sure what works is really the problem,'' he said. ``Being in the hospital isn't a cure for TIA.''

The study also was funded by the American Heart Association and National Stroke Association.