Some Minor Strokes Lead to Disability

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By Denise Mann
WebMD Health News

Reviewed by Louise Chang, MD

Sept 13, 2012 -- Minor strokes and transient ischemic attacks (TIAs) are red flags for full-blown strokes in the future. But new research suggests that they can lead to disability in their own right.

A TIA, sometimes called a "mini stroke," causes stroke-like symptoms, but they last for less than 24 hours.

Fully 15% of 499 people who had a minor stroke or TIA had some disability 90 days later. The type of disability seen in the study included being unable to perform previous activities, but still being capable of handling personal affairs on one's own.

Minor stroke or TIA symptoms may include:

Inability to move one side of your bodyNumbness on one side of the bodyDizzinessSevere sudden headacheDifficulty speaking

In the study, people who had blocked brain arteries and/or ongoing or worsening symptoms were more than twice as likely to have some disability at 90 days. Others who were at higher risk for disability included people with type 2 diabetes and women. More than 50% of people who had recurring strokes were disabled at 90 days, compared to 12% of those who did not have a recurrent stroke.

As a result, the study authors suggest that some high-risk people may benefit from the same clot-busting medication given to people who've had major strokes. These medications can help stave off lasting disability after a stroke, but must be given within a specific time frame.

Most people who've had a minor stroke do not get these drugs because the condition was thought to be too mild.

The new findings appear in Stroke.

"Patients with symptoms initially perceived as minor have a high risk of disability. This is especially true in patients with blocked or narrowed arteries," says researcher Shelagh Coutts, MD. She is a neurologist at Foothills Hospital in Calgary, Alberta, Canada.

"Time is an issue, and even when patients [show] 'mild' deficits they need to be assessed very quickly, and ideally get urgent brain and blood vessel imaging," she says. "In many centers, these patients are not seen urgently and this needs to change."

Coutts and colleagues are now conducting a study to see if clot-busting drugs are effective in minor stroke patients with blocked blood vessels in the brain.

"There has been accumulating evidence regarding the not-so-great 90-day outcomes seen after mini or minor strokes," says Ralph Sacco, MD. He is chair of neurology at the University of Miami Miller School of Medicine and a past president of the American Heart Association.

The message is clear: If you or someone you love has stroke symptoms, seek evaluation ASAP. "Even if the symptoms vanish or get better, it is still urgent to get medical attention," he says. "You may not be out of the woods. Symptoms could come back or get worse and cause lasting damage."

Andrew Slivka, MD, agrees. He is a neurologist at Ohio State Wexner Medical Center in Columbus. "We have moved toward getting these people evaluated sooner so we can treat them and/or prevent a recurrent stroke," he says.

Treating with clot-busting drugs may prove challenging because of the time constraints, he says. Some people may benefit from preventive measures aimed at getting better control over risk factors for stroke, including smoking, high blood pressure, and diabetes.

Many doctors don't think about rehab for people after minor strokes, but the new findings suggest this may be an option for some people as well.

SOURCES: Shelagh Coutts, M.D, neurologist, Foothills Hospital in Calgary, Alberta, Canada. Coutts, S.B. Stroke, 2012, study received ahead of print. Ralph Sacco, MD, chair of neurology, University of Miami Miller School of Medicine, Florida. Andrew Slivka, MD, neurologiost, Ohio State Wexner Medical Center, Columbus, Ohio.

©2012 WebMD, LLC. All Rights Reserved.

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Strokes More Common in Southern States: CDC

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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- While fewer people in the United States are dying from strokes, the number of strokes has remained about the same, health officials report. And their findings bear out the South's reputation as the nation's so-called "stroke belt."

According to the report on stroke prevalence from 2006 to 2010, the number of self-reported strokes dipped slightly from 2.7 percent to 2.6 percent during that time. However, disparities still exist by geography, race and ethnicity, says the U.S. Centers for Disease Control and Prevention.

"Overall, there is not much change in these five years," said lead report author Dr. Jing Fang, an epidemiologist in CDC's Division of Heart Disease and Stroke Prevention.

Only two states -- Georgia and South Dakota -- showed a significant decrease, she added.

However, deaths from stroke decreased significantly, with the CDC reporting a 3.6 percent decline from 2007 to 2008. More people survive strokes primarily because of better treatment.

Since this report is based on people reporting they had a stroke, it's no surprise that reported strokes did not drop significantly, and actually an increase in reported stroke would be expected, Fang said.

"Since mortality has decreased it means that more people say: 'yes, they had a stroke,'" she said.

The report was published in the May 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Geographically, there continues to be high incidence of stroke in Southeastern states, although some other states had high rates.

States with the highest rates of stroke include South Carolina, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Tennessee, Kentucky, Missouri and Nevada.

Those with the lowest rates include New York, Michigan, Colorado, Minnesota, Wisconsin, Wyoming and the New England states.

Older people, American Indians/Alaska Natives, blacks and people with lower levels of education had more strokes than younger people, whites and those with higher levels of education, the researchers found.

The disparities in stroke, a leading cause of long-term disability, are largely due to lifestyle factors including obesity, high blood pressure and smoking, Fang said.

"Southern states have higher rates of obesity, smoking and hypertension, which are all risk factors for stroke," she said.

This is also true for blacks and American Indians/Alaska Natives, and people with lower levels of education, Fang said.

Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine, said it is "reassuring that some of our stroke prevention efforts seem to be working."

However, he said, "The disparities in stroke prevalence by age, race and education continue to highlight the importance of stroke in certain segments of our population who need more intensive stroke prevention and treatment efforts."

Sacco noted that with an aging U.S. population, better data and monitoring will be needed to avoid higher rates of stroke in the future.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jing Fang, M.D., epidemiologist, Division of Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention; Ralph Sacco, M.D., professor and chairman, neurology, professor and chairman, stroke and clinical cerebral vascular diseases, University of Miami Miller School of Medicine; May 25, 2012, Morbidity and Mortality Weekly Report

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Strokes More Common in Southern States: CDC

AppId is over the quota
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By Steven Reinberg
HealthDay Reporter

THURSDAY, May 24 (HealthDay News) -- While fewer people in the United States are dying from strokes, the number of strokes has remained about the same, health officials report. And their findings bear out the South's reputation as the nation's so-called "stroke belt."

According to the report on stroke prevalence from 2006 to 2010, the number of self-reported strokes dipped slightly from 2.7 percent to 2.6 percent during that time. However, disparities still exist by geography, race and ethnicity, says the U.S. Centers for Disease Control and Prevention.

"Overall, there is not much change in these five years," said lead report author Dr. Jing Fang, an epidemiologist in CDC's Division of Heart Disease and Stroke Prevention.

Only two states -- Georgia and South Dakota -- showed a significant decrease, she added.

However, deaths from stroke decreased significantly, with the CDC reporting a 3.6 percent decline from 2007 to 2008. More people survive strokes primarily because of better treatment.

Since this report is based on people reporting they had a stroke, it's no surprise that reported strokes did not drop significantly, and actually an increase in reported stroke would be expected, Fang said.

"Since mortality has decreased it means that more people say: 'yes, they had a stroke,'" she said.

The report was published in the May 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Geographically, there continues to be high incidence of stroke in Southeastern states, although some other states had high rates.

States with the highest rates of stroke include South Carolina, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Tennessee, Kentucky, Missouri and Nevada.

Those with the lowest rates include New York, Michigan, Colorado, Minnesota, Wisconsin, Wyoming and the New England states.

Older people, American Indians/Alaska Natives, blacks and people with lower levels of education had more strokes than younger people, whites and those with higher levels of education, the researchers found.

The disparities in stroke, a leading cause of long-term disability, are largely due to lifestyle factors including obesity, high blood pressure and smoking, Fang said.

"Southern states have higher rates of obesity, smoking and hypertension, which are all risk factors for stroke," she said.

This is also true for blacks and American Indians/Alaska Natives, and people with lower levels of education, Fang said.

Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine, said it is "reassuring that some of our stroke prevention efforts seem to be working."

However, he said, "The disparities in stroke prevalence by age, race and education continue to highlight the importance of stroke in certain segments of our population who need more intensive stroke prevention and treatment efforts."

Sacco noted that with an aging U.S. population, better data and monitoring will be needed to avoid higher rates of stroke in the future.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Jing Fang, M.D., epidemiologist, Division of Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention; Ralph Sacco, M.D., professor and chairman, neurology, professor and chairman, stroke and clinical cerebral vascular diseases, University of Miami Miller School of Medicine; May 25, 2012, Morbidity and Mortality Weekly Report

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