Research appearing in the American Heart Association journal Stroke indicates that a CT scan of the brain within 24 hours of a mild, nondisabling stroke can help predict when patients will be at the highest risk of another stroke or when symptoms may worsen.
Jeffrey Perry, MD, MSc, co-senior author of the study and associate professor of emergency medicine at the University of Ottawa in Canada, recommends all patients get a CT scan of their brain post-transient ischemic attack (TIA) or nondisabling stroke.
“Images can help healthcare professionals identify patterns of damage associated with different levels of risk for a subsequent stroke or help predict when symptoms may get worse,” Perry explains in an American Heart Association news release.
Perry adds that most, if not all, Canadian and US patients with these symptoms undergo CT scanning. The release notes that among the 2,028 patients who received CT scans within 24 hours of a TIA or nondisabling stroke, 40.1% exhibited brain damage resulting from ischemia.
When compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was 2.6 times greater if the CT image revealed newly damaged tissue resulting from acute ischemia. Additionally, the release reports the probability was 5.35 times greater if tissue was previously damaged in addition to acute ischemia; 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of small vessels, in addition to acute ischemia; and 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.
According to the release, while 3.4% of patients in the study group sustained a subsequent stroke within 90 days, 25% of patients with CT scans showing all three types of damage to their brain had strokes.
Perry points out that, “During the 90-day period, and also within the first 2 days after the initial attack, patients did much worse in terms of experiencing a subsequent stroke if they had additional areas of damage along with acute ischemia.”
Perry emphasizes that the research’s findings should encourage physicians to be more aggressive in managing patients with TIA or nondisabling stroke who are diagnosed with acute ischemia, particularly if there is additional chronic ischemia and/or microangiopathy.
The release states that researchers are now looking to determine how to integrate the study’s findings into stroke risk scores that rely on symptoms along with patient factors, including age and the presence of high blood pressure or diabetes.
[Source(s): Science Daily, American Heart Association]
