According to neurologists, they have created a fast test to evaluate the risk that a person suffering a transient ischaemic attack (TIA), or "mini stroke," will have a major stroke in the subsequent forty eight hours.
The test joins elements of two earlier predictive evaluations. The previous tests were designed to determine the risk of a stroke within seven and ninety days, respectively.
"We took each element in those tests, combined them into a whole series of new scores, picked the best one, and validated them in new cohorts," informed Dr. S. Claiborne Johnston, associate professor of neurology at the University of California, San Francisco, and lead author of a report published in the journal The Lancet.
Every year around 240 000 TIAs - minor blockages in brain arteries - are diagnosed in the United States, and up to 20 per cent of them will be followed by a major stroke. It’s essential to evaluate the immediate danger, due to the fact that fifty per cent of those strokes will take place within the first two days after a TIA, Johnston explained.
He also said that his new test can be administered in several minutes. It measures the following: blood pressure, speech impairment, weakness on one side of the body, diabetes and age.
Risk factors
Using these tests on a great number of patients experiencing TIAs revealed that 21 per cent were at high risk, which means they had a 1-in-12 chance of experiencing a stroke in the following forty eight hours. Another 45 per cent were classified as being at moderate risk, with a 4.1 per cent likelihood of a stroke.
"This is the first large-scale research to authenticate these scores," Johnston said. "We are at a new level where we can feel confident that the scores are useful in clinical practice in the Western world."
The test can be helpful in determining which patients ought to be hospitalized and which can be securely sent home, he added.
"We hope that neurologists, emergency doctors and primary care doctors will hear about this score and begin using it commonly," Johnston said. "Nowadays, it doesn’t seem that healthcare providers are making decisions based on risk. They are hospitalizing patients whether they are at great risk or not."
Hospitalization
According to Dr. Brett L. Cucchiara, assistant professor of neurology at the University of Pennsylvania, at present he hospitalizes each patient suffering from TIA. The reason, he informed, is real doubt about the value of all risk-assessment tests.
His observation of the new report is that it is "very interesting and indicates that this strategy can be useful." However, Cucchiara also said "we really have to see these sorts of findings replicated by an independent team before they are ready for prime time."
He pointed to the new research conducted by Portuguese scientists, about to be published, that seems to have discredited the method of an earlier stroke risk-assessment.
Predictive value
"In their research, which was much larger, there was no predictive value at all," Cucchiara said. "I’m not sure if these tests are proven enough to send patients home from the emergency room."
Another report in the same issue of the journal found that MRI is better than the widely used CT scan for the detection of acute stroke.
The research included 356 patients. It was performed at the U.S. National Institute of Neurological Diseases and Stroke and discovered that MRI detected stroke and brain hemorrhages more often than CT, and that MRI should be the preferred test, despite its additional cost.
