Minor Strokes, TIAs increase risk of disability [Stroke]

Image: CC/L. Henry

Key study points:

1.      15% of patients with minor strokes/TIAs were disabled within 3 months.

2.      In addition to positive CT/CT angiography and ongoing symptoms, the risk of disability was increased in women, diabetics, and those with a worse NIH stroke score.

Primer:  TIAs and minor strokes account for a significant amount patients with stroke who show up in emergency rooms. However, many patients do not receive thrombolysis as their stoke is considered “too mild.” Currently, risk assessment after minor stroke or Transient ischemic attack (TIA) is focused on recurrence, not disability and standard assessments may not capture all deficits that may cause disability.

This [prospective] study: To assess potential predictors of disability after TIA or minor stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤3), the authors followed up with 499 patients to the Foothills Medical Centre in Calgary, Alberta, Canada. Using the modified Rankin Scale ≥2, 15% (74/499) of patients had a disabled outcome at 90 days (95% CI 12% – 18%). Of these 74 patients, only 26% had had a recurrent event.  The baseline characteristics associated with disability included: age ≥60y, diabetes mellitus, higher baseline NIHSS score, positive findings on MR diffusion-weighted imaging and high-risk CT findings. Multivariate analysis of baseline variables found significant predictive ability for: Diabetes mellitus OR 2.3 (95% CI 1.2 – 4.3), ongoing symptoms in emergency department OR 2.4 (95% CI 1.3 – 4.4), positive CT/CT angiography OR 2.4 (95% CI 1.4 – 4), and female sex OR 1.8 (95% CI 1.1 – 3).

In Sum:  The authors noted that these results are surprising. Increased emphasis should be placed on clinical assessment and imaging data to examine the risk of disability, especially in patients presenting with minor stroke/TIA. Furthermore, in patients with ongoing symptoms and abnormalities on imaging, treatment options such as thrombolysis should be considered.

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