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“Mini-Strokes Should be Treated Promptly, but Often They're Not

Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in March in the journal Neurology.

Eighty percent of strokes are ischemic, caused by the narrowing of the large or small arteries of the brain, or by clots that block blood flow to the brain. They are often preceded by a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that shows symptoms similar to a stroke, but they are temporary, and do not injure the brain.

“We have known for some time that TIAs are often a precursor to a major stroke,” said study author Peter M. Rothwell, M.D., Ph.D., of the department of clinical neurology at Radcliffe Infirmary in Oxford, England. “What we haven't been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.” (Neurology, March 8, 2005 www.neurology.org)

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TIAs Not Treated Aggressively

Figure. Patients mus...
Figure. Patients mus...
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The Neurology study shows that people who have TIAs should be treated aggressively and promptly, but too often, they're not.

“TIAs represent a ticking time bomb,” says Bhuvaneswari Dandapani, M.D., medical director of the stroke center at Holmes Regional Medical Center in Melbourne, Fla., the study's lead author. He emphasizes that people who have a TIA can prevent a major stroke by undergoing the same type of diagnostic testing, treatment, and education as do stroke patients.

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Common symptoms of a TIA include

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

* Sudden confusion or problems understanding

* Sudden difficulty speaking

* Sudden vision difficulty in one eye or both

* Sudden dizziness, loss of balance or coordination, or difficulty walking

* Sudden, severe headache with no apparent cause.

Unlike a stroke, the symptoms of a TIA typically last only about five minutes, although they can persist for up to a few hours. (Stroke, February 2005, www.ahajournals.org)

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Stroke Survivors, Don't Stop Taking Aspirin

If you're a stroke survivor, it may not be wise to stop taking your daily prescribed aspirin. If you do, you may increase your risk of having another stroke with in the month.

This study's findings reinforced the importance of aspirin therapy in patients who have had a previous stroke. Earlier studies had found similar results, but this was the first trial to compare stroke survivors who had discontinued taking aspirin with those who were still taking the drug, says Patrik Michel, M.D., co-author of the study and director of the acute stroke unit at Lausanne University Hospital in Lausanne, Switzerland. The study was presented at the American Stroke Association's International Stroke Conference 2005.

The study involved only a relatively small number of people who had stopped taking aspirin, so more research needs to be done to determine the exact amount of risk that is involved. Still, the study showed that the risk is real, and that stroke survivors—and their doctors—should be made aware of it, researchers said. (Stroke, February 2005, www.ahajournals.org)

Figure. Aspirin ther...
Figure. Aspirin ther...
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Keep Your Doctor Informed

If you have epilepsy and you use complementary or alternative medications, tell your neurologist. Some of these substances can interfere with conventional medical treatments, but many people keep this information to themselves.

That was the finding of a study by researchers from the University of California in San Francisco's department of clinical pharmacy.

The researchers surveyed 187 people with epilepsy and found that most of them (56 percent) used one or more of these products, including vitamin or mineral supplements, and herbal and other natural products.

Unfortunately, 19 percent used a product (St. John's Wort, echinacea, or garlic) that can interfere with epilepsy medications, and 14 percent used one (ephedra, ginseng, evening primrose, or ginko) that may increase seizures.

More studies are needed before determining the benefits and risks these types of substances pose for people with epilepsy, but, the research shows that if you use them, you should tell your doctor. (American Epilepsy Society's 58th Annual Meeting, 2004)

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To Learn More …

These organizations also offer information about the News Scan topics discussed here:

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Epilepsy

American Epilepsy Society, 342 North Main St. West Hartford, CT 06711, (860) 586-7505 www.aesnet.org

Epilepsy Foundation, 4251 Garden City Drive, Landover, MD 20785-7223, (800) 332-1000 www.epilepsyfoundation.org

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Stroke

American Stroke Association, National Center, 7272 Greenville Ave. Dallas, TX 75231, (888) 4-STROKE, (888) 478-7653 www.strokeassociation.org

National Stroke Association, 9707 East Easter Lane, Englewood, CO 80112-3747, (800) 787-6537 www.stroke.org

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For More Information in Patient Pages

The American Academy of Neurology journal Neurology publishes special Patient Pages. To learn more about the topics of this News Scan, go to www.neurology.org, click on “Patient Pages,” and go to the following items: “Complementary/Alternative Medicine for Epilepsy,” August 2003 and “Brain Attack: Call 911,” November 2002.

©2005 American Academy of Neurology

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