Mini-strokes Can Precede Catastrophic Strokes | News | Loyola Medicine
Wednesday, November 1, 2017

Mini-strokes Can Precede Catastrophic Strokes, Loyola Medicine Neurologists Report

MAYWOOD, IL -  Each year, more than 200,000 Americans experience mini-strokes called transient ischemic attacks (TIAs).

Patients suffer stroke-like symptoms such as paralysis on one side or difficulty speaking. While symptoms typically go away in less than a few minutes and there's no brain damage, TIAs often are followed by severe strokes.

TIAs are an "ominous prelude to an impending cerebrovascular catastrophe, but also the opportunity to prevent a disabling event," Loyola Medicine neurologists Camilo R. Gomez, MD, Michael J. Schneck, MD and José Biller, MD report in the journal F1000 Research. However, the neurologists add that rapid evaluation and treatment can reduce the risk of stroke by about 80 percent during the dangerous first week following a TIA.

Most strokes are ischemic, meaning they are caused by blood clots that block blood flow to a part of the brain. TIAs also are caused by blood clots, but the clots quickly dissolve or are dislodged. However, there's a 5 to 10 percent risk of suffering a stroke during the 30 days following a TIA, and 15 to 20 percent of ischemic stroke patients report having experienced an earlier TIA.

A TIA requires urgent management, but there is controversy about how to accomplish this: Should patients be temporarily hospitalized, which may be safer, or should they be evaluated on an outpatient basis, which may be more convenient and cost effective? The existing literature is inconclusive. "Both approaches have advantages and disadvantages," the Loyola neurologists wrote.

Traditionally, TIA patients have been admitted for a 23-hour observation period after they come to the emergency department.  A recent alternative is to refer patients to a "TIA clinic", where they are quickly seen by a stroke neurologist, undergo diagnostic tests and have access to a multidisciplinary network of cardiologists, neurosurgeons, vascular surgeons and other relevant specialists.

Therapeutic strategies include antiplatelet therapy (aspirin and other drugs that stop blood cells called platelets from sticking together and forming a clot); Coumadin and other blood thinners; surgery or stent placement to open clogged arteries; therapy to control blood pressure and cholesterol; diabetes screening; and patient education.

"Patients must be counselled about smoking cessation, proper diet (preferably Mediterranean), regular exercise, maintenance of appropriate BMI (body mass index) and limiting alcohol consumption," Drs. Gomez, Schneck and Biller wrote.

The Loyola neurologists, who all specialize in stroke care, concluded: "The diagnosis of a TIA represents the recognition of a medical emergency and an opportunity to reduce the risk of stroke by decisively evaluating the patient and applying any combination of the currently available therapeutic strategies. The future is likely to show additional methods of early diagnosis, better algorithms for stroke risk stratification and enhanced systems of care for these patients."

Drs. Gomez and Schneck are professors and Dr. Biller is professor and chair of Loyola Medicine's department of neurology. Their paper is titled, "Recent advances in the management of transient ischemic attacks."

Loyola’s Stroke Center offers a nationally recognized team of experts in every facet of stroke-related care, including emergency medicine, neurology, neurosurgery, neurophysiology, neuroradiology, rehabilitative services, social work, pharmacy and specialty nursing.

For nine years in a row, Loyola University Medical Center has received the American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.