Despite well-known link to stroke, TIAs still undertreated: study
  HELEN BRANSWELL
Canadian Press
March 29, 2004

http://www.canada.com/search/story.html?id=08375f25-a748-4c4a-84ff-1aaf4
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TORONTO (CP) - People who have suffered a temporary disruption of blood
flow to the brain - a mini-stroke known as a transient ischemic attack
or TIA - are at a 12-fold increased risk of suffering a full-scale
stroke in the days that immediately follow.

Yet new data suggests that despite decades of evidence that TIAs are an
early warning sign of looming problems, the events continue to be
sloughed off by too many doctors. One-third of Ontario patients followed
in a study published in the Canadian Medical Association Journal left
hospital without being prescribed the vital blood thinners that could
prevent stroke, the authors found. As well, follow-up testing with
procedures such as CT scanning and echocardiography was "underused,"
they found.

"We were very surprised," said lead author Dr. David Gladstone, a
neurologist and director of inpatient stroke services at Sunnybrook and
Women's College Health Sciences Centre in Toronto.

"I think the results of this study are really a wake-up call for
patients and physicians alike, that we can't underestimate the danger of
a TIA."

The study was conducted by researchers at the Institute of Clinical
Evaluative Sciences, where Gladstone is a research fellow. It was part
of a package of papers on TIAs which the journal published Tuesday.

Dr. Piero Verro, a stroke expert at the University of California, Davis,
said the package will focus needed attention on TIAs and the fact that
they are often a sign a patient is on the verge of having a major
stroke.

"I just think that TIA has not gotten the amount of attention that it
deserves as a marker for potentially very serious and soon-to-follow
events," Verro, who wrote an accompanying commentary on the issue, said
in an interview from Sacramento.

A TIA is considered a mini-stroke, with symptoms that resolve themselves
after a short while. A person suffering a TIA might experience
short-term paralysis in a limb or the face - typically on one side - or
briefly lose the ability to see or speak clearly.

It's believed they are underdiagnosed. When symptoms pass, people can be
inclined to disregard them as a temporary blip. Even doctors can dismiss
the symptoms, putting them down to a pinched nerve or Bell's palsy.

But since the 1950s, an increasing body of evidence has shown TIAs
aren't a minor or random event. They are forerunners of full-fledged
strokes, themselves a major cause of death and disability.

Every 45 seconds, someone in North America suffers a stroke; every three
minutes, a stroke claims a life on the continent. For every 10 people
who suffer a stroke, two will die and six will suffer permanent
disabilities.

Doctors believe with quick action, strokes could be prevented. If
someone who suffered a mini-stroke was quickly put on blood thinners,
high blood pressure drugs and cholesterol lowering medications, outcomes
would be better, Gladstone said.

But those regimes aren't always recommended, leaving patients at high
risk - even in the short term - of another brain attack.

C The Canadian Press 2004